[Therapy of hepatitis B. Practical implications]. There is as yet no specific treatment for viral hepatitis, and in an uncomplicated course no further action apart from moderate bedrest is necessary. The patient should however, be isolated in a special ward. In fulminant hepatic failure the benefit of glucocorticoid therapy is still controverted and appears to depend on an early beginning. Treatment with HBsAg-rich human serum in fulminant hepatitis B is still under evaluation. In chronic active hepatitis the administration of azathioprine in combination with glucocorticoids is highly effective, and it appears to be irrelevant whether HBsAg is present in plasma or not; however, the best results have been achieved in "lupoid" hepatitis. The use of transfer factor, laevamisol or thymosin to suppress T-cell action on antibody production of the B-cells cannot yet be finally evaluated with respect to its effectiveness in chronic active hepatitis. Prevention is of major importance in solving the problems involved in hepatitis B infections. Recent experience with active immunization using HBsAg-rich sera or purified formalin inactivated HBsAg preparations suggest the possibility of successful vaccination against hepatitis B in the near future, but the precondition for obtaining sufficient quantities of vaccine is to find suitable culture media for the virus.


[Detection of 3 beta-hydroxy-5-cholenoic acid in human amniotic fluid]. Studies of the bile acids of human meconium suggest that a fetal pathway of bile acid synthesis exists which leads to formation of 3beta-hydroxy-5-cholenoic acid, a bile acid not found in serum of healthy pregnant women. To obtain additional support for this hypothesis, cholic, chenodeoxycholic, and 3beta-hydroxy-5-cholenoic acid were measured in amniotic fluid specimens from 18 pregnant women without liver disease. The finding of a considerable percentage of 3beta-hydroxy-5-cholenoic acid (mean: 34 molar %; range 3-71 molar % of total bile acids) in amniotic fluid strengthens the hypothesis that a fetal pathway of bile acid synthesis exists which begins with oxidation of the cholesterol side chain.


[How reliable is radiology in the diagnosis of large bowel carcinoma?]. In 262 patients with clinically suspect cancer of the large bowel, results of barium enemas were evaluated. Testing method was coloscopy. Out of 62 cases in which barium enema revealed a "typical" carcinoma, 17 were false positive. In 81 of 110 cases in which the result of barium enema was questionable, a malignant lesion could be ruled out. In 17 out of 90 cases with negative radiologic findings a carcinoma was found.


[Radiation injuries of the intestine. Review of 40 cases]. Among 442 patients treated by radiotherapy for intrapelvic carcinoma, the clinical findings in 40 patients with intestinal and urological complications are recorded. The incidence and clinical features of radiation injuries, the factors which may predispose to these injuries and the methods of medical and surgical treatment are discussed.


[Effect of somatostatin on canine exocrine pancreas secretion stimulated by pancreozymin, secretin or test meal]. In 4 dogs with pancreatic and gastric fistulae the effect of somatostatin (SST) on the pancreas was investigated during stimulation by pancreozymin-secretin or by a test meal. The pancreozymin-secretin-induced enzyme output and bile flow, as well as the enzyme concentration and duodenal volume during test meal stimulation were significantly reduced by SST. SST caused a less marked decrease in bicarbonate concentration, while volume and bicarbonate output did not change.


[Aneurysm of the abdominal aorta. Diagnostic, prognostic, and the therapeutic knowledge after review of cases and the literature]. Report on 80 patients with aneurysm of the abdominal aorta seen in this clinic during the period January 1968 to December 1974. They are divided into three groups, viz. asymptomatic, symptomatic and ruptured. The indication for and urgency of surgery are discussed and the results in 62 surgical cases are compared with those in 18 where surgery was not performed. The difficulties encountered in the diagnosis of ruptured aneurysm of the abdominal aorta are outlined. Only in these cases can the prognosis still be decisively improved by early recognition and immediate treatment.


[Radiologic diagnosis of abdominal aortic aneurysm. Value of abdominal radiography, ultrasonic tomography and abdominal aortography]. Radiological diagnosis of arteriosclerotic abdominal aortic aneurysm is discussed. This review is based on the evaluation of 70 abdominal plain films and 58 aortograms. In addition, 11 aneurysms have been examined by ultrasound tomography (grey-scale technique). In 15% of patients referred with suspicion of aneurysm, the diagnosis could not be confirmed radiologically or operatively. The diagnosis of abdominal aortic aneurysm can be established in 80% of patients on the basis of the abdominal plain films. Ultrasonography gives better results as a screening method, since it renders a definite diagnosis possible in about 98% of cases and unnecessary arteriography can thus be avoided. However, preoperative abdominal aortography remains indispensable for demonstration of the exact anatomic details and pathologic changes in the large abdominal and pelvic arteries. The risk involved in this examination are minimal. Suprarenal or combined supra- and infrarenal aneurysm were found in 9% (5 patients), and renal artery stenosis or obstruction in 12% (7 cases). Obstruction or stenosis of the celiac artery and the superior mesenteric artery were present in only 2 patients with suprarenal expansion of the aneurysm. The angiographic-anatomic correlation is excellent, and only very infrequently is it impossible to determine exactly the distal extent of the aneurysm (2 patients).


[Pharmacokinetic effect of various antibiotics in the tissues]. The tissular pharmacokinetics of antibiotics were studied by sacrificing rats in groups of 6 at various intervals after the injection of ampicillin, cephalothin, doxycycline, gentamicin and sisomicin. A microbiological method was used to determine levels in 10 organs. The antibiotic penetrated rapidly into all the tissues but with very different affinities depending on the organ involved. The concentration of doxycycline in the tissues was always higher than in the serum and this relationship was maintained throughout the investigation. This was not true of ampicillin which disappeared a little more slowly from the organs, particularly the renal medulla, than from the serum. The aminosides showed a marked accumulation and prolonged persistence in the renal cortex: 4 weeks after injection concentrations were found which were above the maximum levels in the serum. When daily injections of 4 mg/kg aminoside were given, concentrations above 350 mug/g were found after 7 days. These findings permit a better understanding of antibiotic effectiveness and toxicity.


[Primary and secondary hypertension in polyclinical patients]. Hypertension was found in 854 (10.4%) of 8228 patients (3657 females, 4571 males) seen in our outpatient clinic during 1975. Essential (primary) hypertension was found in 92.9% (n = 793) of all hypertensives. Among secondary forms of hypertension (7.1%) renal hypertension, with a rate of 5.8%, was the commonest form (hypertension of renal-parenchymatous origin 4.9%, renovascular hypertension 0.8%, hypertension associated with unilateral hydronephrosis 0.1%. In 2 patients (0.2%) the underlying disease was primary aldosteronism and in 5 (0.6%) coarctation of the aorta. In 4 female patients (0.5%) the hypertension was caused by oral contraceptives. Patients with essential hypertension had higher body weight than those with normal blood pressure. These differences were statistically significant in young and middle-aged patients. Our results show a very high percentage of essential hypertension. In only 18 (2.1%) of 854 hypertensives was a curable form of high blood pressure found (hypertension caused by renal artery stenosis, hydronephrosis, aldosterone producing adenoma of the adrenal gland and oral contraceptives). The very low percentage of curable forms of hypertension should be kept in mind when deciding on expensive procedures in a search for secondary forms of high blood pressure.


Echo-detecting characteristics of neurons in inferior colliculus of unanesthetized bats. Neurons in the inferior colliculus of echolocating bats responded well to two stimuli presented in close temporal sequence. Favorable recovery of responsiveness was seen with stimuli having durations, intensities, and interpulse intervals similar to the natural biosonar signals reaching the ears during the various phases of echolocation. Some units responded to a subthreshold simulated echo but only when preceded by a loud initial pulse. These units appear to be specialized for echo-detection.


Acute dermatomyositis-polymyositis and malignancy. A partial review of selected published case reports of AD-P associated with malignancy has been enhanced by the presentation of pertinent data on 15 unreported examples of the association. It is noteworthy that the first case in current literature of AD-P associated with a malignancy was described in 1916. The brief clinical report of a patient with proximal muscle weakness and skin lesions, with the obvious association with a malignancy (adenocarcinoma of the stomach), describes an example that has been repeated many times with different types of tumors but with essentially no variations in the clinical findings. In 1959 Williams identified 590 cases of AD with an overall tumor rate of 15%, and recently Barnes identified 258 cases of AD associated with a malignancy. The original designation, dermatomyositis or AD, has now been expanded to include proximal muscle polymyositis with systemic involvement, which syndrome at the current state of the art is indistinguishable clinically and pathologically from AD except for the lack of skin lesions. It may be that at some future time one or more immunologic features may differnetiate the clinical entity polymyositis from AD and further subdivide each of these entitites from similar clinical syndromes associated with a malignancy. However, the problem in management in either AD or polymyositis is similar. A number of patients with a malignancy and muscle weakness or neuropathy have been reported. These associations have been mentioned briefly, but insufficient data are available to determine whether these should be considered as a variant of AD-P or only casually related conditions with certain clinical features in common. Most of the patients described in the literature of AD-P with an associated malignancy have had skin lesions; a minority only have lacked this feature. However, unless a patient is followed carefully, it is possible for a transient or evanescent erythema or insignificant skin lesions to be present and not recorded in the case record.


Basic principles of computed axial tomography. Computer tomography (CT) is a radiological imaging method which yields transverse tomographic images reflecting with high accuracy the spatial distribution of x-ray attenuation in the part examined. The contrast resolution achieved by CT permits the visualization of soft tissue structure heretofore invisible with conventional radiographic procedure. The CT image is reconstructed by a computer applied algorithm, from a series of x-ray attenuation measurements obtained at different angles around the subject, by means of radiation detectors; The signal to noise ratio for these measurements is optimized by reducing the contribution of scattered radiation and of system noise. The CT principle of image reconstruction is also applicable in nuclear medicine imaging, with the goal of achieving contrast improvement and quantitative assessment of radionuclide distribution over conventional "projection" techniques. In this application, however, the attenuation of the radiation in the tissue interposed between the radionuclide and the detector must be taken into account to yield quantitatively accurate images. Furthermore, the variation of the field of view of the collimator as a function of distance contributes another unwanted variable to the reconstruction process. A mathematically rigorous tomographic reconstruction which would account for these variables is unavailable for gamma ray-emitting radionuclides, although approximate solutions of that problem have led to the satisfactory images of the head. Images of larger inhomogeneous organs are less quantitative. The detection of coincidence annihilation counting of positron-emitting radionuclides allows the accurate correction for the attenuation of that radiation in tissues and permits depth independent collimation which renders these radionuclide particularly suitable for their imaging by CT. A number of CT devices designed for the imaging of positron emitting radionuclides are yielding nuclear medicine images of quality and potential clinical usefulness unequaled by more conventional projection techniques.


Computed cranial tomography and radionuclide cisternography in hydrocephalus. Computerized Cranial Tomographic scanning has replaced radionuclide cisternography in screening both adult and pediatric patients for hydrocephalus. Nevertheless, cisternography provides indispensable information about the CSF clearance capacity and remains a valuable adjunct to the excellent anatomic detail provided by CCT scans. In patients without emergency symptoms, cisternography provides the best indication as to whether or not diversionary shunting is likely to relieve the patient's symptoms.


Medical and psychosocial problems of the aged. A survey of chronic illness in the 65-year-and-over age group in general practice is presented. Some medical and psychosocial problems encountered in this age group are discussed.


Geriatric care in a provincial hospital. Much of the work of the public medical wards at Grey's Hospital is concerned with the care of aged persons. In the absence of separate geriatric facilities, this work forms an integral part of internal medicine. During the last decade two surveys, and experience gained, have determined a comprehensive approach to the social and medical problems encountered. While team work can accomplish much, the responsibility for care of the aged currently remains divided among a number of government and private agencies. Without a unified policy and further expenditure of a certain amount of money, many of our senior citizens will continue to be denied easy access to health care facilities.


A socio-economic, health and cultural survey in Soweto. The socio-economic, health and nutritional status of 186 families in Diepkloof, Soweto, was studied. The results, detailed in the text, reveal considerable socio-economic ills, of which the most important is the observation that 30% of the families existed below the poverty datum line, even when there was more than one wage-earner. More emphasis on health education and the promotion by health personnel of a better understanding of the backgrounds of clinic and hospital patients are urgent priorities for health services.


Serum levels of anticonvulsants and haematological sequelae in black epileptics. Serum levels of phenytoin and phenobarbitone were studied in a group of Black adult epileptics. Therapeutically satisfactory levels of phenytoin were observed in only 11,3% of patients, and of phenobarbitone, in 63,9%. An overall non-compliance rate of about 50% was noted. The possible reasons for this are discussed. Folate deficiency was not a major problem in this group of patients.


[Value of scintigraphy in the treatment of single nodules of the thyroid]. The value of radionuclide scanning of the thyroid gland was investigated in 125 patients with solitary thyroid nodules. Fifty-seven of the 95 patients with 'cold' nodules underwent surgery. The incidence of malignant nodules in this group was 16%; therefore surgery is recommended for all solitary 'cold' nodules. Of the 30 patients with 'warm' nodules, 20 were treated surgically and in only 1 patient was the nodule malignant. This incidence is probably not significant. Surgery is, however, also recommended for all solitary 'warm' nodules because of the possibility of toxic change. Accurate planning of the surgical procedure depends on any function of the nodule in question and this can be determined with certainty only by radionuclide scanning.


Morphology of colony variants of the rough form of Dermatophilus spp. A technique is described for the preparation of intact colonies of Dermatophilus and their study under the scanning electron microscope. Using this technique with 38 strains of the organism it is possible to describe for the first time the patterns of colony morphology and to study the relationship of hyphae, cocci and zoospores in situ. Colonies were found to possess both vegetative and aerial hyphae. The various patterns of mycelial activity and structure that were seen raised serious doubts about the previous concepts of the mode of propagation and thus the classification of Dermatophilus within the Actinomycetales.


[Coccidioides immitis: isolation from soil samples in San Luis and Mendoza provinces]. By using the double pour plate method, Yeasts Extract Agar (YE) which contained a high concentration of chloramphenicol-streptomycin sulfate and cycloheximide,, and by inoculating mice intraperitoneally, we succeed in the isolation of different strains of Coccidicides immitis from 12 samples of the soils collected in the province of San Luis and from 1 of the province of Mendoza (Argentina), a 70% of the samples turned out positive. Identification of the strains was based on macro- and micro-morphology of the colonies, pathogenicity for mice and the capacity to transform in shaked cultures.


Studies on mediators of cellular immunity in experimental coccidioidomycosis. The time course of delayed hypersensitivity (DH) to spherulin was regularly detected 3 days before and up to 140 days after sensitization of guniea pigs by repeated testing with the in vitro macrophage migration inhibition method. The properties of mycelial and spherule-derived coccidioidins in dermal sensitivity reactions were studied with regard to infected or vaccinated with Coccidioides immitis guinea pigs. The mediators for cellular immunity such as promotion of phagocytosis, skin reactive and fungicidal factors can be found in the supernatant of lymphocyte cultures from vaccinated or infected animals with mild disease in much greater quantity than those in control or infected with severe disease. Cell-mediated immunity to Coccidioides immitis involves both macrophages and lymphocytes, but the latter was the most likely mediator of the intracellular killing observedl


Coinsurance and the demand for physician services: four years later. In 1971 a study was made of the effects of a 25-percent coinsurance provision on the demand for physician services under a comprehensive prepaid plan for medical care. Comparing physician utilization rates in 1966 (the year before coinsurance was introduced) and 1968 (the first calendar year after the change) showed that coinsurance led to a 24-percent decline in the per capita number of all physician visits that held true regardless of how the data were examined--whether by demographic characteristics of the study population, physician specialization, or place of visit. This effect of coinsurance could be temporary--a kind of shock effect that would wear off. Since there was no conclusive proof of this hypothesis, the authors conducted a followup study, comparing physician utilization rates in 1972 and 1968. They found no evidence of any upward trend in the use of physician services. The overall utilization rate was much the same in 1972 as in 1968, and the rates of the demographic subgroups and types of visits were either much the same or slightly lower. Equally important was the finding that the plan had become relatively unattractive for families in the lowest socioeconomic group who constituted a smaller proportion of the 1972 plan membership than of the pre-coinsurance membership.


Penetrating wounds of the neck: principles and some controversies. Some of the principles, pitfalls, and controversies in the management of penetrating wounds of the neck have been reviewed. All three policies to exploration of the neck advocated by different authors have merit and can be considered optimal under certain circumstances. Since delayed surgical treatment of major vascular and esophageal injuries results in higher morbidity and mortality, exploratory operations are appropriate when such injuries are suspected, even though preoperative studies are inconclusive. A systematic approach to the management of penetrating wounds of the base of the neck has been outlined. The role of a shount to maintain adequate cerebral blood flow during repair of carotid artery injuries has been discussed. In patients who have severe preoperative neurologic deficit and no blood flow in the injured carotid artery at operation, ligation of the artery rather than repair of injury appears to be indicated.


Vascular trauma.

Vascular trauma. The word "spasm" has been purposefully omitted as it is essentially a nonentity in vascular trauma. The surgeon's ability to repair and salvage extremities has increased greatly in the last 30 years. Problem areas still exist, especially in those patients with carotid trauma and neurologic deficit and patients with massive trauma to the extremities with involvement of bone, arteries, veins, nerves, and soft tissue. There is a place and a time for primary amputation, but its role in trauma surgery has definitely decreased and should continue to do so, as long as in so doing we do not jeopardize the life of the patient.


Fractures and dislocations encountered by the general surgeon: general principles. The definitive treatment selected for the care of a fracture is dependent upon what will offer the best cosmesis and function for the individual patient. Closed reductions and immobilization which require the joints to be in abnormal positions may offer an anatomic reduction but after the fracture is healed, joint function may be poor. Consequently, immobilization in the functional position with early motion and acceptance of some deformity is often better in terms of the ultimate use of the extremity. Traction treatment which requires prolonged recumbency is dangerous in the elderly because of the threat of thromboembolic phenomena and pneumonia. Therefore, open reduction and internal fixation with early mobilization of such patients is preferred. The type of treatment used is based on an evaluation of the entire patient and not just the radiographic interpretation of the fracture.


Urologic injuries.

Urologic injuries. We have reviewed our experience in 311 cases of urologic trauma seen at Detroit General Hospital. A properly organized emergency surgery team is necessary to handle these types of injures effectively. We feel that, whenever possible, evaluation of any patient suspected of genitourinary trauma should be accomplished by a urologist before the patient enters the operating room. We approach renal injuries with a conservative viewpoint, trying to preserve as much renal tissue as possible, yet realizing that at time an aggressive approach to renal injuries is necessary to accomplish this and to save the patient's life. The injuries of the renal pelvis and ureter should be treated by debridement and a water-tight anastomosis with a fine absorbable material. It is our impression that patients suffering from gunshot wounds, because an ideal anastomosis is not possible, do better with a stented anastomosis. Ruptures of the bladder are simple to repair and attention is focused on the diagnosis and exploration of associated ureteral injuries. The prostatomembranous disruptions are without question one of the most difficult injuries in urology. Although we attempt to stent the urethra in order to align the ends, we condemn a vigorous attempt with interlocking sounds or other instruments since they may lead to iatrogenic injuries of the urogenital diaphragm. In these cases suprapubic cystostomy drainage and secondary repair is indicated. Our results with a group of patients with injuries of the anterior urethra showed that the overwhelming majority of these patients did well with a suprapubic cystostomy and drainage with no immediate repair.


Vaccination with Bordetella bronchiseptica vaccine on a farm with atrophic rhinitis: an evaluation of a field experiment. On a farm where Atrophic rhinitis (AR) occurred the animals were vaccinated with a Bordetella bronchiseptica vaccine. The immune state of the sows was checked and also the effect of this vaccination on the antibody titre of the piglets. Groups of pregnant sows were vaccinated once or twice before the partus, another group of sows only had their piglets vaccinated and a third group were used as control. The serum titres of the sows were low, not higher than 1:100 before vaccination. A double vaccination of the pregnant sows induced the piglets to produce antibodies in a sufficiently high titre during the first 7 weeks of life. Vaccination only against Bordetella bronchiseptica did not protect the piglets against AR. Piglets of the vaccinated sows showed two types of titre progress. It is not recommended to vaccinate the piglets only. The rapid plate agglutination was found extremely useful for the early diagnosis of Bordetella bronchiseptica infection.


Effects of feed restriction on heat production, body temperature and respiratory evaporation in the White Leghorn hen on a "tropical" day. The effects of a shift in the time of feeding on heat production, body temperature and respiratory evaporation in the White Leghorn hen were studied on a "tropical" day. The thermogenic effect of feed at an ambient temperature of 35 degrees C, as compared to 20 degrees C, was delayed for 2 to 3 hours, its magnitude was not as great and the duration was prolonged for 8 to 10 hours. Depriving the chickens of their feed between 0500 to 1200 hours, between 0830 to 1730 hours or for the whole period on a "tropical" day at two different humidity levels did not result in a significant decrease in heat stress during the period with the highest ambient temperature. An ambient temperature range was found in which the body temperature increased while heat production decreased.


Rotavirus infections in calves. II. Experimental infections with a Dutch isolate. Rotaviruses were observed electron microscopically in clarified faecal samples from calves with diarrhoea. Several herds with a history of scouring among neonatal calves were shown to be infected with rotaviruses. A bacteria-free faecal filtrate from a rotavirus positive sample administered orally induced diarrhoea in one out of two colostrum-deprived calves. Both calves excreted rotaviruses in their faeces and serum antibody responses were demonstrated by complement-fixation and indirect immunofluorescence tests and by immune electron microscopy. Purified rotavirus from faeces of the first calf induced profuse diarrhoea in three other colostrum-deprived calves, with subsequent shedding of the virus in the faeces. These calves also showed a serum antibody response. All calves recovered in one to seven days without treatment. Two colostrum-fed calves were removed from a rotavirus-affected dairy farm within 36 hours after birth and studied at the Institute. Both animals excreted rotaviruses and developed severe diarrhoea, although they had circulating maternal antibodies. Attempts to grow this rotavirus in cell cultures were not successful.


Mediastinal cyst in a dog.

Mediastinal cyst in a dog. An eleven-month-old long-haired German pointer with a cyst on the medial side of the left lung is described. The content was a mucous liquid in a quantity of 400 ml. The cyst was the cause of a heavy dyspnoca. After removal of the cyst, the animal improved quickly. The origin of the cyst could not be determined definitely probably it was a congenital bronchogenic cyst.


Responses of crayfish muscle preparations to nerve stimulation with various patterns of impulse sequence. Effects of intermittent, intercalated and adaptational types of impulse sequence. The present study was carried out with an attempt to see what effects would be produced by various patterns of impulse trains other than pulses of a definite frequency in nerve-muscle systems of the crayfish. Single axons of nerves of the opener, the slow closer and the fast closer of the crayfish claw were stimulated and the tension development of muscles were recorded. The impulse trains tested are as follows: (i) intermittent stimulation; e.g., paired (doublet) and triplet stimuli, (ii) the intercalated stimulation during stimulation by constant-frequency pulses and (iii) the adaptational type of stimulation, i.e. a train of pulses of which interval gradually increases as seen in the process of the adaptation in the sensory nerve. Results obtained are as follows. Intermittent doublet stimuli produced a greater tension than the monotonous stimulation of the same average frequency. Repetitive triplet or quadruplet stimuli caused further increments in the tension development. Intercalation of a stimulus during usual monotonous stimulation induced a catch-like effect on the tension. Intercalated triplet stimuli provoked a stronger catch action. With the adaptational type of stimulation, an initial rapid tension development occurred with a least latency and this was followed by a maintained tension. There are certain temporal configurations of stimuli which produced a greater tension or a more physiologically meaningful time course of tension development. This suggests the significance of nervous coding.


Detection of A, B and H(O) antigens in normal and neoplastic epithelium of the urinary bladder by the specific red cell adherence test (SRCA). A, B and H(O) blood group antigens in some tissues are readily demonstrable by the specific red cell adherence test (SRCA) which is a modification of Coomb's mixed cell adherence technique. Paraffin-embedded tissue sections obtained from tumors of the urinary bladder were submitted to SRCA. Normal bladder epithelium adjacent to neoplastic lesions and the leukoplakia were found to contain the three antigens. The antigens were completely absent in 18 cases and partially present in one of the bladder carcinoma. It was also suggested that the prognosis of the tumor correlates with the antigen loss. SRCA is sensitive, reproducible and technically easy for detection of tissue antigens, and it would be expected to play a crucial role for demonstration of immunological dedifferentiation in tissues which normally keep the antigens.


Clincial and edidemiological studies on hepatitis B in children. Sera from children with various clinical categories of hepatitis were examined for hepatitis B surface (HBs) antigen (Ag) by radiommunoassay and for antibody to HBsAg (anti-HBs) by the passive hemagglutination test. It was found that frequencies of HBsAg and anti-HBs in 56 cases of acute hepatitis were 55% (31/56) and 11% (6/56), respectively. All of 4 patients with chronic hepatitis were found to have persistent HBs antigenemia. As for hepatitis in infant under the age of 6 months HBs Ag was detected in 2 each of 31 cases of neonatal hepatitis and of 15 cases of anicteric hepatitis. The data suggest the importance of HB virus as an etiologic agent of acute and chronic hepatitis in children in this country, however, other agents were supposed to be responsible for hepatitis in early infancy. Anti-HBs Ab was first detected in 15% of a group of children age from 3 to 5 years in Rishiri Island and in 12% of children aged from 6 to 9 years in Sapporo City. Frequency increased gradually through school age in both areas. Thus, HB virus infection seems to be common in the childhood population in urban as well as rural area of Hokkaido district.


Biological fate of 32P malathion in Gallus domesticus (desi poultry birds). During this study, a minor surgical technique was developed for the separation of urine and faeces in birds and fate of 32P malathion was studied, following a single oral dose of 394 mg/kg. The birds showed characteristic signs and symptoms of organophosphorus poisoning and the results suggested that the compound is rapidly absorbed from the gastro-intestinal tract, significant quantities being detected in plasma after 0.5 h of ingestion. Highest concentration of 32P was present during 6 to 8 h of administration. At 6 h, 32P was highest in liver followed by other organs. With the lapse of time the concentration of 32P in various organs decreased at 48 h, it was not detected except in liver, kidney, lung and spleen when only traces were observed. The cumulative urinary and faecal excretion study revealed that within 24 h 90% is rapidly excreted mainly via the urine and only small amounts in the faeces. Metabolism studies showed that the compound is quickly metabolised. Because of the rapid turnover of the compound, this study indicated that the accumulation of this compound is unlikely in the body system.


Pharmacokinetics of vinyl chloride in the rat. When rats are exposed to [14C]vinyl chloride in a closed system, the vinyl chloride present in the atmosphere equilibrates with the animals' organism within 15 min. The course of equilibration could be determined using rats which had been given 6-nitro-1,2,3-benzothiadiazole. This compound completely blocks metabolism of vinyl chloride. The enzymes responsible for metabolism of vinyl chloride are saturated at an atmospheric concentration of vinyl chloride of 250 ppm. Pharmacokinetic analysis shows that no significant cumulation of vinyl chloride or its major metabolites is to be expected on repeated administration of vinyl chlorides. This may be consistent with the theory that a reactive, shortly living, metabolite which occurs in low concentration only, may be responsible for the toxic effects of vinyl chloride.


Effect of talc injected intravenously in guinea pigs. The pulmonary angiothrombotic lesions in narcotic addicts attributed to the talc present in drug tablets were studied experimentally in guinea pigs following repeated intravenous administration of a suspension of talc dust (75 mg per animal). In early periods there was a moderate localization of talc particles in the alveolar capillaries of lung, liver and abdominal lymph nodes. The vascular injury in the pulmonary tissue was in the form of mild proliferation of the endothelial cells. In addition, many nodular collections comprising macrophages and lymphocytes developed around such vascular structures. At later periods (150 days) the only significant reaction obtained was moderate thickening of interalveolar septa and the lesions were in no way comparable to the human reports. The significance of these findings has been discussed.


The binding of CS2 in central nervous system of control and phenobarbitone-pretreated rats. The binding of 35S- and 14C-labelled CS2 in rat central nervous system (CNS) was studied in control and phenobarbitone-pretreated rats in vivo and in vitro. Animals received CS2 through intraperitoneal injection in olive oil. Samples were taken for analysis 3 and 6 h after the injection. Sulphur atoms were bound to rat brain more highly than carbon atoms in control and phenobarbitone-pretreated rats in vivo. The phenobarbitone pretreatment increased the cerebral binding of sulphur and decreased that of carbon. Main part of the bound sulphur and carbon was detected in the trichloroacetic acid (TCA) precipitable fraction in both test groups. Pretreatment with phenobarbitone or with polychlorinated hydrocarbon (PCB) mixture did not increase significantly the binding of CS2 sulphur in brain microsomes in vitro. The present findings suggest that a considerable amount of injected CS2 is retained in the nervous system and that phenobarbitone pretreatment of test subjects may also alter brain metabolism of CS2.


Semichronic oral toxicity of cadmium. 2. Studies on dogs. Cadmium in the form of CdCl2 was administered with the feed in concentrations of 0, 1, 3, 10 and 30 ppm over a period of 3 months to groups of 2 male and 2 female beagle dogs each. The appearance, behaviour food consumption, growth and mortality of the treated dogs in all groups was not affected. In the groups up to 30 ppm cadmium caused no detectable harm to blood, liver or kidneys. The systolic and diastolic blood pressure of the treated animals of all groups up to 30 ppm was within the normal range. The autopsies and histopathological investigations revealed no evidence of any damage. Cadmium accumulated dose-dependently above all in the kidneys and liver. The dogs tolerated concentrations of up to 30 ppm cadmium in their feed over a period of 3 months without harm.


Cytogenic investigations on leucocytes of cattle intoxicated with fluoride. Cattle which grazed in the vicinity of a plant manufacturing enamel and which displayed signs of chronic fluoride poisoning such as osteosclerosis and mottled enamel or dental fluorosis were investigated for the presence of structural chromatid and chromosome aberrations. Venous blood was incubated for 48 h, and 100 cells were analyzed for each animal. No statistical difference in the incidence of such anomalies was observed between the controls and the intoxicated animals.


Toxicological evaluation of Norpace after intravenous administration to rat and dog. Norpace (disopyramide phosphate) is a drug for treating cardiac arrhythmias. It has been evaluated for potential toxicological effects in albino rats and Beagle dogs, to provide safety support for clinical studies involving intravenous infusion. The compound was dissolved in Sodium Chloride for Injection, U.S.P. and administered daily by continuous intravenous infusion to groups of rats and dogs. Dose levels to 4.95 mg/kg/h for 14 and 28 consecutive days, respectively were employed. Rats received the formulation for 6--12 h daily; dogs were infused for 6 h daily. Conventional physical, cardiovascular, hematology, clinical chemistry and postmortem gross and microscopic examinations were performed. No compound-related changes were observed in the physical examinations (including ophthalmic), blood pressure (rat), ECG (dog), body weight, or clinical lab parameters evaluated; Food consumption was unontinuous restraining procedure employed during infusions reduced food consumption in all dogs, however, Postmortem examination did not reveal any lesions unique to treated animals. Some dogs exhibited intravenous fibrin thrombi at the site of injection. Organizing blood clots were occasionally present in the thoracic cavity of the rat. These findings were considered related to the infusion technique employed, rather than the drug administered. It was concluded that daily intravenous infusions of Norpace at doses up to 4.65 mg/kg/h to rats and dogs for 14 and 28 consecutive rays respectively, cause no biologically meaningful detrimental effects.


[Clinical staging classification of non-Hodgkin's lymphomas (author's transl)]. The Ann Arbor classification of malignant lymphomas is interpreted in detail, and, in consideration of the diagnosis of non-Hodgkin's lymphomas, modifications are proposed.


[A retrospective analysis of cases with non-Hodgkin-lymphomas treated in the radiological clinic of the Kiel University between 1969 and 1975]. 141 cases with malignant Non-Hodgkin-lymphomas are reported. The stage and results of radiological and/or cytostatic treatment as performed at the radiological clinic of the Kiel University have been related to the histological diagnosis according to the Kiel classification. Therewith, the differentiation by the pathologist between low-grade and high-grade malignancies is evidently clinically relevant.


[Radiation therapy in renal adenocarcinoma (author's transl)]. Sole irradiation treatment for renal carcinoma or its metastases has to be regarded as only a palliative therapy, whereas postoperative radiation therapy brings about a distinct diminution of the frequency of local recurrences, and, at least in advanced tumor stages, an improvement of the 5-year survival rate. Long-term preirradiation (ca 3000 rd TD within 3 weeks, and operation after another three weeks) or short-term pre-irradiation (ca 1200 to 2000 rd TD within 2 or 4 days, and operation the next day) are tolerated well and do involve no disturbances of the wound healing. Surgical treatment is not complicated by short-term irradiation, but often is easier following long-term irradiation; beyond this, the latter may just render possible a radical extirpation of the renal tumor. It appears from first results that decrease of distant spread and improvement of recovery rates in advanced tumor stages may be within reach, particularly in connection with post-operative irradiation.


[Intensification of the oncolysis by clostridia by means of radio-frequency hyperthermy in experiments on animals--dependence on dosage and on intervals (author's transl)]. The effect of a local pretreatment by radio-frequency hyperthermy upon the capability of germination and, hence, upon the oncolysis by intravenously given spores of oncolytic clostridia (M55) was tested with 2305 NMRI-mice carrying neck tumors. Using two different experimental tumors (Ehrlich adenocarcinoma and Harding-Passey-melanoma) it is possible to show the dependence of the intensification on the thermic dose. Additionally, there is a distinct dependence of the extent of oncolysis on the time interval between the hyperthermy treatment and the administration of clostridia. The intensification effect in both the tumors is mostly marked twelve hours after hyperthermy. The rapidly growing Ehrlich adenocarcinoma regenerates more quickly than the slowly growing Harding-Passey-melanoma. A period of 12 hours between hyperthermy and injection of clostridia represents a favourable interval for the timing of slowly as well as of rapidly growing tumors.


Allogeneic and semiallogeneic immunizations with a strong transplantation antigen (Ag-B). A comparison has been made between the alloantibody response evoked by graded doses of cells being allogeneic and semiallogeneic with the host. The responses were measured by hemagglutination and complement-dependent lymphocytotoxicity. In the strain combination of rats used (DA leads to HO), a marked difference in the optimal dose was found after i.v. injection of lymphocytes. Although semiallogeneic cells gave the better antigenic stimulus at lower cell doses (0.3 and 3 X 10(6) cells), allogeneic cells were better at higher cell doses (30 and 150 X 10(6) cells). Immunization experiments with allogeneic and semiallogeneic erythrocytes or mitomycin- or heat-treated lymphocytes indicated that the antigenicity of the cells was not directly related to the cell surface concentration of antigen and was independent on the proliferative capacity of the lymphocytes; it was, however, curtailed by heat treatment of these cells. The 3 X 10(6), but not the 0.3 or 30 X 10(6) dose of semiallogeneic cells primed efficiently for a secondary hemagglutinin and cytotoxic response. I.v. injected 51Cr-labelled allogeneic and semiallogeneic lymphocytes showed different localized patterns. Between 4 and 24 hr after injection allogeneic lymphocytes were apparently more rapidly lost from the recipient lymph nodes. Collectively, these data indicate that the different immunizing properties of i.v. injected allogeneic and semiallogeneic lymphocytes are not simple consequences of the antigen dose transferred, but suggest that different localization patterns might influence the ability of these cells to induce cytotoxic and hemagglutinating alloantibody formation.


Possible evidence for a new C-locus specificity: studies of the serum Pullium. We have presented data from our own experience and from the first serum exchange of the HLA Workshop of the Americas that indicate the serum Pul may identify a new low-frequency specificity of the C locus. One informative family has been studied, and the results are consistant with a C-locus inheritance pattern. No correlation was found with antisera that identify known antigens of the A, B, or C locus. One additional serum, also available for study, seems to react with the same specificity as the serum Pul.


New observations on pressure-induced motor disturbances in a small mammal. New observations on pressure-induced motor disturbances in a small mammal. Undersea Biomed. Res. 4(1):1-8.-Adult and baby mice were subjected to helium pressures up to 120 atm. Pressure-induced changes in motor acitivity (tremors and convulsions) were monitored both visually and with a noninvasive mechanical transducer. A study of five rates of compression showed that adult convulsion pressure thresholds (Pc) fell from a maximum of 90 atm at 20 atm/hr to a minimum of 63 atm at 610 atm/hr, Pc for baby mice rose from 53 atm at 8 days to reach the adult value (85-90 atm) at 21 days of age. Measurements of accommodation, or the decline in motor disturbances at constant pressure, are described. Animals allowed to accommodate for five hours at a pressure 9% higher than the first Pc (85 atm) and then compressed further showed a significantly higher second Pc (114 atm) than animals allowed one hour to accommodate (100 atm). The effects on including nitrogen in the heliox compression mixture on accommodation are also described.


Changes in left ventricular activity during apnea and face immersion. Apneic face immersion in water has been analyzed with respect to its effects upon heart rate and ventricular function in a group of highly trained teenaged swimmers of both sexes. Both parameters have been studied on a beat-by-beat basis throughout the maneuvers and analysis of the systolic time intervals has provided a noninvasive tool for studying changes in ventricular function. It was observed that the pre-ejection period of systole is lengthened, while left ventricular ejection time shows little change with apnea, face  wetting (27 degrees C), or a combination of these. This decrease in ventricular function, however, lags behind the previously well-recognized decrease in heart rate, a difference which is particularly obvious when face immersion is performed in the postexercise state. This suggests ventricular function changes are regulated separately from heart rate changes and thus may be a secondary effect. Analysis of the face immersion reflex on a beat-by-beat basis has also revealed a more rapid development of bradycardia with colder (15 degrees C) water. A model has been developed to describe the face immersion reflex in the light of these findings and previous information.


Converting standard air decompression tables for no-stop diving from altitude or habitat. Using the phase equilibration theory of Hills (1966), as modified by Hennessy and Hempleman (1977), it is possible to predict formulas for converting standard air decompression tables for no-stop diving at altitude or from a normoxic habitat, breathing air. For diving following equilibration at altitude, the Royal Navy, Royal Naval Physiological Laboratory, and Haldane-type rules appear to be too conservative, with the opposite result for diving after excursion to altitude. Predictions in the latter case are in fair agreement with the Swiss (Boni, Schibli, Nussberger, and Bühlmann 1976) no-stop altitude tables. In the case of habitats, close agreement is found between the Hamilton, Kenyon, Freitag, and Schreiner (1973) normoxic tables for no-stop downward excursions and indefinite dive upward-excursions on air. In the case of flying directly after no-stop diving, the US Navy rule of using repetitive group D appears to be conservative for dives less than 50 fsw, and possibly unsafe for dives over 50 fsw. It is concluded that for no-stop diving a single tissue and single safe ascent pressure formula are all that is necessary to generate equivalent air dives. This enforces the hypothesis that it is the volume of gas released on ascent that governs marginal type I bends, and that in a no-stop ascent, all excess dissolved gas is released in the worst case.


Evidence of bacteremia and endotoxemia in mice undergoing hyperbaric stress. Swiss albino mice were exposed to normoxic (PO2 approximately 0.2 ATA) helium at 1, 20 or 35 ATA for 2 or 48 h and examined for the presence of bacteria and endotoxin in selected tissues. Among mice exposed to 35 ATA for 48 h and tested immediately after decompression for bacteria in liver and peritoneal cavities, 6 of 30 (20%) contained gram-negative rods and 27 of 30 (90%) contained gram-positive cocci. Incidence of infection was considerably less in mice exposed to 35 ATA for 2 h or exposed to 1 ATA. Evidence of presence of gram-negative rods and /or escape of free endotoxin from the intestine was provided by demonstration  that limulus lysate is coagulated (presumptive evidence of endotoxin) by liver homogenates in 70% of the mice exposed to 35 ATA for 48 h, 68% of those exposed to 20 ATA and 14% of those exposed to 1 ATA. Mice subjected to the hyperbaric stress of 35 ATA for 48 h were shown to be increasingly susceptible to injection with purified lipopolysaccharide. The LD50 was 0.24 mg for hyperbaric exposed mice and 0.39 mg for the control groups. These data suggest that hyperbaric stress, but not necessarily decompression, results in a short-term presence in mouse tissues of microbial agents originating from the gut. This invasion temporarily renders that host more susceptible to additional endotoxic challenge.


Does the evoked response measure inert gas narcosis? The purpose of this review is to examine the validity of change in the cortical evoked response as a measure of inert gas narcosis in humans. Three criteria are defined which must all be met if a nonbehavioral measure is to be accepted as an indicator of narcosis. The evoked response is assessed in terms of these criteria. Two classes of experiments which have used the evoked response in hyperbaric ocnditions are identified. The first class allows the evoked response to be assessed against more than one of these criteria. The outcome of every experiment in this class supports the view that the evoked response is not a valid measure of narcosis. The second class of experiment assumed that the evoked response is a measure of narcosis and were not designed to assess validity appropriately. Arguments by Kinney and associates in support of the assumption of validity are shown to be unsound. Possible explanations for inability to demonstrate validity are discussed and it is suggested that factors other than narcotic potency of the breathing gas mixture determine or at least play a major role in determining amplitude of the evoked response.


Eustachian tubal function during immersion. The effects of head-out immersion on active and passive middle ear pressure equilibration were studied in three otologically normal scuba divers. Results were compared with the equilibration capacity recorded in the nonimmersed sitting and supine positions. Head-out immersion had only a minor effect on the ability to equilibrate the middle ear pressure actively during descent; passive ear clearing during ascent was slightly more difficult compared with this capacity in the sitting nonimmersed position. In the supine position ear clearing was significantly more difficult during both ascent and descent, which indicates that it is preferable to assume an upright body posture during exposures to pressure changes in dry pressure chambers. Mechanisms that might influence the ability to equilibrate the middle ears are discussed.


Anterior urethral injury: etiology, diagnosis, and initial management. Urethral injuries below the urogenital diaphragm may result from external trauma or instrumentation. The most severe complication is the development of a urethral stricture. Proper care of the acute injury will diminish this possibility. In the hands of an experienced perineal surgeon repair of the externally traumatized urethra should consist of urethral debridement, mobilization, spatulation, and primary anastomosis. If an experienced surgeon is not immediately available, a suprapubic tube should be placed after draining the perineum. When major injuries occur requiring life-saving procedures and immediate care of other problems, the urine should be diverted with a suprapubic tube and urethral repair carried out later.


Penetrating renal injuries and the management of renal pedicle injury. Injury to the upper urinary tract from penetrating trauma frequently is associated with injury to other abdominal organs. Management of the renal injury requires knowledge of the effect of injury of these other organs on the renal repair. Frequently the associated injury may dictate a need for nephrectomy when a complicated procedure would be necessary for repair of the kidney, but one should always keep in mind the high incidence of acute renal failure found in penetrating abdominal injuries and make a maximum effort to converse renal parenchyma in these patients. If renal repair is attempted, watertight repair of the renal collecting system, adequate debridement of injured renal tissue, accurate assessment of the presence or absence of blast effect, meticulous hemostasis, and adequate drainage are imperative.


A personal view of the immediate management of pelvic fracture urethral injuries. 1. The best treatment for all but the most severe urethral injuries associated with pelvic fractures must surely be suprapubic catheter drainage without local exploration. 2. The free drainage of exudates from an injured urethra is be obstructed by the larger sizes of standard-shaft indwelling catheter; the use of a standard shaft catheter in an injured urethra requires careful consideration in relation to the individual problem and should not be a routine; however, a fenestrated catheter may have some positive advantages. 3. The results of treating the less severe fracture-dislocation injuries by suprapubic catheter are sufficiently good to make any attempt at immediate local readjustment of incomplete dislocations inadvisable for all but those with a special experience of the surgery of the traumatized urethra. 4. If abdominopelvic exploration has to be undertaken for non-urologic indications, the repositioning of a dislocated bladder base by the aligned sling-suture technique is a relatively simple procedure which can be swiftly and reliably accomplished by an emergency surgeon. 5. The treatment of a urethral injury, even if severely dislocated, is not in itself a matter of immediate urgency once suprapubic catheter drainage has been established; however, exploration for continued bleeding may be. If bleeding is controlled by local tamponade there may be considerable advantage in postponing definitive resolution of a massive urethral dislocation for a week or so because the patient is usually fitter and the procedure is less likely to be complicated by serious hemorrhage. When a particular urethral injury is considered suitable for a delayed primary repositioning, the patient may be fit enough to transfer to the care of a urologic department with special experience of these problems.


Histological and ultrastructural changes in rat kidney following cadmium injection. Cadmium injection in rats affects the genito-urinary system. The renal effects are generally considered to be mainly tubular. Light microscopy of 29 specimens confirms cellular damage in the glomeruli with changes in glomerular capillaries. Electron microscopic changes in the glomerulari confirm changes in the podocytes, thickening of the basement lamina, the occurrence of electron dense deposits in association with the capillary endothelium with platelet and polymorphonuclear cell accumulations which suggests opening of the endothelial junction of the glomerular vessels.


Changes in blood flow and vasculature of the dog kidney undergoing normothermic and hypothermic ischaemia. In 11 mongrel dogs both kidneys have been subjected to a 2 h ischaemic period. One kidney was cooled by perfusing the renal artery at 4 degrees C while the contralateral normothermic kidney was clamped for 2 h. Studying the renal blood flow using the Xenon wash out technique, sequential renal scanning and angiography, marked differences between hypo- and normothermic ischaemia kidneys were observed. One or two hours following hypothermic perfusion a marked decrease of blood flow in the first compartment and vasoconstriction was evident, while within this period following normothermic ischaemia an enhanced renal blood flow was observed. After 24 h renal blood flow and renal function tested by 131I-Hippuran clearance returned to normal values. Angiographic studies corresponding to the preoperative findings. In contrast, normothermic ischaemia kidneys showed a decreased renal blood flow, impairment of kidney function in isotope studies and pathological angiographic changes.


[Life expectancy in penile carcinoma (statistical evaluation of 150 penile carcinomas in the period 1912-1970)]. In the period 1912-1970 in the Göttingen area, 150 patients suffering from penis carcinoma were investigated and/or treated. With regard to method of treatment, three periods can be distinguished: 1912-1930, 1931-1948, and 1949-1970. During the first period, treatment was chiefly radiotherapy, in the second chiefly surgery, and in the third combined radiotherapy and surgery. Independent of the type of therapy and period of observation, the 3-, 5-, and 10-year survival rates were 52.5%, 46.7%, and 31.4%, respectively. The greatest life expectancy was that following combined surgical and high-voltage therapy. The importance of lymphography is emphasized.


[Results of radical perineal prostatectomy: 14 years' experience (author's transl)]. One hundred radical perineal prostatectomies are reported, which were performed during the past 14 years. In this series were 36 patients with stage C carcinomas, which could not be operated radically by total prostatectomy. This shows the difficulties in preoperative staging of these tumors. In spite of doing routinely a vesiculography and a lymphography these tumors were frequently undervalued. The 5-year survival rates, being 66.6% in stage A/B and C carcinomas correspond nearly to the results of Belt. The postoperative incontinence rate was 10%. Only two patients retained their potency. There were no postoperative mortalities.


[Pelvic lymphadenectomy as a staging operation for prostate carcinome (author's transl)]. As a staging operation for prostate carcinomas in clinical stages B (6/27) and C (21/27), 27 pelvic lymphadenectomies were performed. In stage B, a radical prostatectomy was performed; patients in stage C also received radiation. Preoperatively, lymphographic and histologic findings that were in agreement were available for only 74%. The immediate mortality was 0%, the postoperative morbidity 29%.


[Clinical pathology and treatment of upper urinary tract urothelial tumors--a 10-year review (author's transl)]. Fifty-four patients with upper urinary tract urothelial tumors were treated from 1966 to 1975 at the Urologische Klinik und Poliklinik der Universität Erlangen-Nürnberg. The neoplasms were multicentric in 13 patients (24%). All of the tumors were classified according to the WHO classification and the recommendation of the UICC. The correlations between histologic grade of malignancy and local spread are statistically significant. Lymph node metastases were found primarily with grade 3 tumors and infiltration into outer muscle layer. Nephroureterectomy with radical lymphadenomectomy via transabdominal approach and frozen-section histology of marginal nodes are recommended. The overall 5-year survival rate was 65% (+/- 16%) in all patients with malignant disease.


Ileal substitute of ureter with reflux-plasty by terminal intussusception of bowel: animal experiments and clinical experience. The conflicting results reported after substitution of the ureter by isolated bowel segments suggest that the procedure is still hazardous. This induced us to check experimentally the performance of the ileal ureter with antireflux-plasty before using it clinically. The antireflux mechanism is constructed by intussuscepting the terminal 8 cm. of an isolated ileal segment into each other thus forming a nipple. After vesicoileostomy the nipple protrudes into the urinary bladder. In the pig vesicoileorenal reflux was prevented, and anterograde urinary flow from the kidney through the ileal ureter into the bladder was unobstructed. Finally, the case of a patient is recorded who was submitted to the same procedure successfully.


[Prevention of thromboembolic complications in transurethral resection of the prostate (author's transl)]. 1. The effect of 2 X 500 ml Dextran 70 i.v. for prevention of postoperative deep vein thrombosis in patients with transurethral resection of the prostate was investigated in a controlled, prospective and randomized study. The diagnosis of deep vein thrombosis was made by means of the 125I-fibrinogen test. 2. A total of 86 patients were studied. Two out of 47 in the control group developed deep vein thrombosis and 3 out of 39 in the dextran group. The total number of all thromboembolic complications in the control group is 19.2% as compared to 7.7% in the dextran group. This difference is statistically seen not significant. 3. Dextran prophylaxis showed no side effects. 4. A search of the literature on thromboembolic complications in urology shows the following. The incidence of deep vein thrombosis is general urology is about the same as in general surgery, i.e. every third patient develops deep vein thrombosis. There are no studies which would show that the number of fatal pulmonary emboli can be significantly reduced by any sort of preventive method in urologic patients. 5. The incidence of deep vein thrombosis in open prostatectomies is around 50%. In transurethral resection, however, this figure is between 5 and 10%. But nevertheless there are fatal pulmonary emboli. There exist no studies showing a significant reduction in the incidence of deep vein thrombosis after prostatectomy by any form of prevention. In order to avoid the postthrombotic syndrom and fatal complications, a prevention of thromboembolism seems reasonable, if this form of prevention has minimal side effects.


Dynamics of acute retention in prostatic patient and role of adrenergic receptors. The dynamic changes in the lower urinary tract associated with acute retention in the prostatic patient were investigated by pressure studies. These revealed that the site of maximal urethral pressure was in the prostatic segment, the bladder neck was not tightly closed, and the normal tone of the external sphincter was inhibited. Bladder decompression altered these findings, and alpha-adrenergic blockade produced a reduction in all pressure parameters in the posterior urethra. The significance of the findings is discussed in relation to present-day knowledge of lower tract urodynamics. It is concluded that certain cases of acute retention in the prostatic patient may be initiated by stimulation of the prostatic alpha-adrenergic receptors, and may then be perpetuated by a secondary fall in intravesical pressure together with a supplementaty "feed-back" stimulation of these receptors due to the bladder overdistention itself. Decompression and/or alpha-adrenergic block may sometimes reverse this process.


Varicocelectomy and infertility.

Varicocelectomy and infertility. Eighty males with varicocele underwent internal spermatic vein ligation as therapy for infertility. Semen quality improved in 78 per cent following ligation, and 51 per cent of wives became pregnant. The results in this series compare favorably with previous studies. We believe that spermatic vein ligation is a very successful adjunct in the treatment of the infertile male with varicocele.


Prolapsing urethral polyp in child with hypospadias. This report details the first published case of a urethral polyp presenting as a prolapse through the proximally displaced meatus of a child with hypospadias. Urethral obstruction, a symptom common to other reported urethral polyps, was absent. The congenital nature suggests a benign neoplastic process as the etiologic factor.


Nonpapillary carcinoma in situ and atypical hyperplasia in cancerous bladders: further studies of surgically removed bladders by mapping. Complete mapping of epithelium has been performed in 10 bladders surigcally removed for cancer. In all cases, in areas adjacent to or distant from the visible tumors, nonpapillary carcinoma in situ and related lesions such as atypical hyperplasia could be demonstrated. More importantly, in 5 of the 10 bladders, areas of occult invasive carcinoma derived from such abnormal epithelia have been recorded. These findings fully confirm prior observations and raise the number of totally mapped bladders to 20. The histologic findings in the entire series of 20 cases are discussed and the distribution of cancer and precancerous lesions tabulated. It is suggested that the areas of the bladder most frequently affected by precancerous lesions are the left and right lateral walls and the posterior wall. The trigone and the dome are less frequently involved. The need for aggressive assessment of bladder epithelium in patients with tumors of the bladder and/or early radical treatment for patients with non papillary carcinoma in situ is discussed in light of these observations.


Educational objectives for residency training in urology. A description of the development of educational objectives for urologic residency training is presented. The purpose of these objectives is to define the knowledge and skills expected of urology residents at the completion of their training. Twenty-six urologists from residency programs throughout the country, one resident, and one medical educator formed a task force for the Society of University Urologists to write these objectives. During a one-year period, fifty-five sets of objectives were drafted, reviewed, and revised into the present form. Discussion of the methodological problems and implications for residents and program directors are included.


Laryngeal involvement by systemic lupus erythematosus. Indirect laryngeal photography with the rod laryngeal telescope provided an excellent method of documenting evolution of the laryngeal pathology in two cases of systemic lupus erythematosus. This disease may have mucosal or serosal manifestations in the larynx. Currently, management of mucosal disease includes acute and long-term corticosteroid therapy, and should the airway become compromised by edema or scarring, then tracheostomy and specific laryngeal reconstruction during a quiescent period in the disease is required. The course of serosal involvement, notably cricoarytenoid arthritis, may be followed by observing vocal cord motion sequentially and assessing the degree of throat pain. Oral corticosteroids in maintenance dosages is the accepted modality of treatment, with dosage being boosted for exacerbations.


Some aspects of cervical chordoma.

Some aspects of cervical chordoma. This paper reviews 13 cases of chordoma in the cervical spine and base of the skull which have been seen at the Pack Medical Foundation over the past 25 years. Chordomas are dysonto genetic, malignant, slow-growing neoplasms that arise in remnants of the embryonic notochord. Concealed along the axial skeleton, these slow-growing tumors are usually well entrenched before they are accurately diagnosed. The majority of the chordomas of the spine occur in the sacroccygeal region. Of the 13 cases in the area of the cervical spine, 39% occurred in the region of the base of the skull and 61% in the area of the cervical spine. The treatment of the cervical tumors consisted of laminectomy to relieve the pressure on the cord and to remove as much of the neoplasm as possible. Some of the tumors at the base of the skull were nonresectable and were treated with radiotherapy. Radiotherapy was ultimately used in every case, either in combination with surgery or as a primary or subsequent method of management. The overall prognosis for palliation was fair but ineffective for cure.


[Results of subdiaphragmatic vagotomy for perforated ulcer in the region of the pylorus and duodenum]. Within the recent 7 years in the clinic 400 operations of trunk vagotomy with drainage of the stomach were performed for complicated ulcers of the duodenum, 110 of them - in perforating ulcer. The postoperative mortality was 1.8%. The immediate and late results were studied within the terms from 6 months to 6 years. Good results were obtained in 79.9%, satisfactory - in 17.6%. Poor issues were noted in 1 patient, who was reoperated upon gastric resection being performed.


[Effect of different types of vagotomy on the contractile activity of the gall bladder]. Based on the analysis of serial cholecystography, performed in 112 patients, the authors concluded that trunk and selective vagotomy associated with economic gastric resection, selective proximal vagotomy with and without drainage of the stomach do not essentially influence the contractile capacity of the gallbladder. Following selective and trunk vagotomy in early postoperative terms dilation of the gallbladder was noted, which, however, was transitory. Selective proximal vagotomy with and without drainage of the stomach does not influence the size of the gallbladder.


XXXII Wherry Memorial Lecture. The ear surgeon of tomorrow. Tympanomastoidectomy techniques and classification. The ear surgery of the past 40 years (1936-1976) has been reviewed to demonstrate how this has influenced the development of modern microsurgery and the ear surgery of the future. The ear surgeon of tomorrow must have complete knowledge of the surgical anatomy and surgical pathology of the temporal bone, that pathology which has been produced by my generation of ear surgeons, and all techniques of all surgeons, for there is no single approach to surgery of the temporal bone. Only with complete and total knowledge of the temporal bone obtained by personal dissection can the surgeon succeed in the first operation. In unsheltered private practice, the patient will rarely give the surgeon a second chance. Residual postoperative cholesteatoma is divided into two types, encapsulated and exfoliative. In carcinoma of the external auditory canal, parotidectomy is advocated in continuity with the block resection of the external auditory canal. The classification of tympanoplasty is presented. Fenestration of the horizontal semicircular canal remains the operation of choice in bilateral congenital conductive deafness with stenosis of the external auditory canal, particularly in adult Treacher Collins syndrome. The evolution of the stapes techniques is presented with a view toward the diagnosis of future complications, and the postauricular transcanal approach is recommended for the removal of glomus tumors in the hypotympanum and removal of the jugular bulb.


[Value of thermal fractionation of lactate dehydrogenase and the protein composition of the blood in the differential diagnosis of the phases of acute pancreatitis]. Under examination were seventy nine patients with acute pancreatitis (23 patients with edematous form and 56 - with necrotic one). To test the method of thermal fractionation the studies were conducted in patients with hepatic lesions (the Botkin disease - 15 patients, hepatic cirrhosis - 15 patients). The most pronounced shifts were found in destructive processes in the pancreas, whereas no significant changes were noted in edematous form of acute pancreatitis. In necrotic pancreatitis structural changes in the liver were observed. The employed methods of investigation can prove to be useful for estimation of acute pancreatitis phases and the degree of liver involvement in the inflammatory process.


[Rare diseases of the small intestine in emergency surgery]. The work is based on the analysis of clinical observations over 18 patients with a rare pathology of the small intestine, who needed an urgent operative intervention. These included 7 patients with intestinal phlegmon, 1 - with terminal ileitis, 1 adult patient - with intestinal invagination, 3 patients - with benign tumors of the small intestine, 6 patients with intestinal infarction. The absence of characteristic symptoms for each of these lesions was the main cause of an erroneous diagnosis preoperatively.


[Comparative assessment of truncal and selective vagotomy combined with gastric drainage in the treatment of duodenal ulcer]. Comparative estimation of trunk and selective vagotomy associated with stomach drainage operations in treatment of duodenal ulcer revealed no essential advantages of selective vagotomy in comparison with trunk one. At the same time, technically trunk vagotomy is a more simple procedure and a more reliable one in relation to ulcer cure. The question concerning high-risk of calculi formation in the gallbladder after trunk vagotomy in females is unsolved yet and needs further studies.


[Corrosion of the matallic constructions and matallosis of the tissues in the treatment of bone fractures]. Under observation were 192 patients in whom metallic construction were with-drawn. Clinical and metallographic findings indicated that till present time surgical specialists employ unjeustifiable big variety of stainless steels and titan alloys. Corrosion was noted in 18%, tissue metallosis--in 25%, fracture of fixators--in 12%, inflammatory response--in 11%. Compaound metallic constructions produced from different metals and alloys were subjected to corrosion 3 times as fregquntly. To thoroughly study the metallosis of tissues these were investigated by meands of a special analysis and histochemistry.


Reconstructive procedures on the denervated gullet. The loss of function of the vagus nerve resulting from radical tumor surgery may require some sort of pharyngeal rehabilitation. This may be accomplished by excision of the denervated muscularis as in partial pharyngectomy. This allows the remainder of the newly formed gullet to be innervated, with 80% to 90% of the innervation provided by the vagus nerve of the contralateral side. Extramucosal myotomy, temporary tracheostomy, and a bypass nasogastric feeding tube are required. However, nasal regurgitation may occur in velopharyngeal insufficiency. A technique is described by using two nasopharyngeal local flaps to narrow the velopharyngeal entrance on the paralyzed side.


Povidone-iodine: an adjunct in the treatmen of wound infections, dehiscences, and fistulas in head and neck surgery. Extensive research has been done to elucidate the cellular and biochemical events of a healing wound. Similarly, new techniques are continually being investigated which would stimulate and augment the reparative process. This paper describes the uses and biochemistry of povidone-iodine which has gained widespread acceptance as a surgical preparation. However, its use as a topical agent for treating head and neck wound infections, dehiscences, and salivary fistulas has gained little recognition. Povidone-iodine is a unique compound formed by binding free iodine to polyvinylpyrrolidone. Previously, the toxic effects of iodine limited its use to preparation of the skin for surgery. When bound to the pyrrolidine molecule, iodine becomes water soluble and markedly less toxic. As a result, the broad antimicrobial spectrum of iodine may be used topically to control wound sepsis. It can be applied to mucosal surfaces without producing burns. The brown color acts as an indicator of its clinical effectiveness. When the dressings become light yellow or pale, free iodine is no longer being released and the dressing should be changed. Povidone-iodine is not a panacea for correcting interruption in the healing process during the postoperative period. The basic management of wound infections, dehiscences, and fistulas remains unchanged. Incision and drainage, debridement and flap contracture, lateralization, and diversion are necessary to initiate the healing process. Familarity with each phase of healing provides the basis for managing each of these surgical problems. Topical povidone-iodine not only controls wound sepsis but augments wound healing. The physiologic correlation with each phase of wound healing for these various surgical problems is elaborated and clinical cases presented.


[Diagnosis of benign neoplasms of the mediastinum]. An analysis of 252 patients with benign tumore and cysts of the mediastinum indicated that high per cent (35%) of diagnostic errors is conditioned by the absence of clinical signs typical for this pathology, as well as rather similar roentgenological symptomatics in its different forms.  Following resection of large neoplasms, when it proved unfeasible to close the pleural defect (the removed tumor bed) by suturing its margins, the aughors performed alloplasty with lyophilized pericardium or dura mater. Pleural alloplasty was employed in 18 (8.7%) patients. In all 206 operated patients no significant postoperative complications were observed. There were no lethal issues. Ii is felt that plastic repair of pleural defects should be considered absolutely essential while removing benign mediastinal neoplasms.


Pigmented villonodular tenosynovitis of the temporomandibular joint. A case report of pigmented villonodular tenosynovitis involving the temporomandibular joint is presented. The lesion had destroyed the ascending ramus and condyle of the mandible, anterior cartilaginous wall of the external auditory meatus, and a large part of the squamous portion of the temporal bone. Surgery included resection of a portion of the mandible, temporal squama, and dura of the temporal lobe with replacement by a fascia temporalis graft. Four years postoperatively, the patient is free of any evidence of recurrent disease. A discussion of the differential diagnosis of an infratemporal mass, natural history, and pathology of pigmented villonodular tenosynovitis are discussed herein.


[Effect of vagotomy on the motor function of the gallbladder]. 409 roentgenological studies were performed, using the method of serial cholecystography prior to and after giving a bile-expelling breakfast, in 102 patients with duodenal ulcer, in 174 patients after trunk and in 89 patients after selective vagotomy with pyloroplasty. It was found that the volume of the gallbladder beyond the digestion act following trunk vagotomy is increased by 20%, on the average, by 30%--after selective vagotomy. It is concluded that there are no principal differences in the influence of trunk and selcetive vagotomy on the tonus and motility of the gallbladder.


[Change in the architectonics of the azygous visceral arteries after surgical interventions on the abdominal cavity organs]. Study of angiograms in 100 patients subjected to resections of the stomach, small and large intestine, splenectomy, cholecystectomy etc. indicated that following these operations one might detect characteristic changes in the architectonics of azygous visceral arteries and their branches conditioned by the extent and kind of surgical intervention. Angiography enable an estimation of the mechanism of compensation or disorders of the blood circulation after resection or removal of the organ. The knowledge of alterations in the architectonics following the operation is of great importgnosis and intensive therapy myoglobinuria showed an abortive character.


[Extended operations in kidney tumor].

[Extended operations in kidney tumor]. The authors treated 220 patients with renal tumors. In 22 cases nephrectomy was supplemented by extensive operations: a removal of tumor thrombus from the inferior vena cava--in 6, lymphadenectomy--in 11. Hemicolonectomy was performed in 1 patient, resection of the pancreatic tail and splenectomy--in 3, resection of the diaphragm, the XII and XIth ribs--in one. Eight patients show an over 3 years survival. All operations were accomplished from the thoracoabdominal access, which is considered by the authors to be the method of choice in patients with tumor of the kidneys. The authors emphasized the necessity of the complex examination of patients with subsequent working out of the unique roentgenotopographic scheme.


[Complications of a paranephric novocaine block for renal colic]. Under observation were 12 patients, in whom following paranephral novocain blockade subcapsular and paranephral hematomas, purulent paranephritis, abscesses and carbuncles of the kidneys developed. All patients were subjected to surgery. In such cases to eliminate renal colic it would be more safe to perform other kinds of theapeutic procedures (the injection of spasmolytic, the blockade after M. Ju. Lorin-Epshtein method, etc) which are not at all inferior in their effect to paranephral novocain blockade.


[Clinical aspects and operative treatment of complicated peptic ulcer in children]. Due to peculiar course of ulcerous process in children, manifested not only by gross morphological changes in the zone of ulcer location but also by profound functional disturbances, it is recommended to resort to surgical interventions prior to the onset of stomach decompensation and development of grave homeostatic disorders. Gastric resection is thought by the authors to be the operation of choice.


[Late results of reconstructive and plastic operations in bladder exstrophy]. During the period of 1961-1975 in the Child Surgery Clinic of Leningrad Medical Institute of Pediatrics reparative-plastic operations for the urinary bladder extrophy were performed in 39 patients. Most of children were operated upon at the age under 1 year. In 36 patients plastic reconstruction of the urinary bladder, sphincter and urethra was performed with local tissues after the Young technic in the G. A. Bairov modification. Late results of surgical treatment were studied in 26 patients within the terms from 1 to 14 years. Good results were gained in 10 patients, satisfactory--in 9, poor--in 7, one of them died.


Polioencephalomalacia of dogs with thiamine deficiency. A naturally occurring neurological disease occurred in six dogs fed cooked meat. Clinical signs were anorexia, progressive spastic paraparesis, recumbency, convulsions and death. The disease was characterized by bilaterally symmetrical spongy change and necrosis of brainstem nuclei with a lesion distribution pattern similar to that in thiamine deficient foxes and cats. An associated thiamine deficiency was evidenced by decreased thiamine levels in the blood of one dog and in the food of another, and rapid remission of clinical signs in a dog given thiamine hydrochloride. Thermal destruction of thiamine through cooking of the foods probably caused the dietary deficiency.


Triaryl phosphate poisoning in cattle.

Triaryl phosphate poisoning in cattle. Clinical signs, pathologic changes and biochemical changes occurred in cattle with natural and experimental triaryl phosphate poisoning. Natural poisoning was caused by triaryl phosphates escaping from a gas pipeline compressor station. The clinical signs were posterior motor paralysis, dyspnea, diarrhea and agalactia. Experimental doses of 1/2-1 gm/kg body weight of these organophosphate compounds caused depression of cholinesterase and axonal degeneration in the spinal cord.


Hypothalamic hamartoma in a dog.

Hypothalamic hamartoma in a dog. A 10-month-old female, Wire-haired Pointing Griffon dog had a hamartoma of the hypothalamus. Episodes of sudden flaccid collapse had increased in frequency and duration for 7 months. Cerebrospinal fluid pressure was normal. A flat, pedunculated mass, 2.5 X 3.0 X 0.9 cm, covered the brain stem between the pituitary gland and pons. Its 1.2-cm-diameter connection to the hypothalamus obliterated the mammillary bodies and extended to the tuber cinereum, distorting the hypothalamus and displacing the third ventricle which also divided the rostral part of the mass. The tissue of the hamartoma resembled gray matter with bullous cytoplasmic vacuolation of many neurons, spongiform change, gemistocytosis and microscopic foci of calcification.


Ochratoxin A and citrinin induced nephrosis in Beagle dogs. I. Clinical and clinicopathological features. Ochratoxin A and citrinin, both mycotoxins, were given separately and combined to young Beagle dogs for 14 days. Ochratoxin A, 0.1 and 0.2 mg/kg, was given by capsule, and citrinin, 5 and 10 mg/kg, was dissolved in ethanol and given by intraperitoneal injection. Clinical signs of toxicosis in dogs given 10 mg/kg citrinin and the higher combined doses included anorexia, retching, tenesmus, weight loss, prostration and death. Severity of the clinical disease and mortality were increased when the mycotoxins were combined, which indicated synergism. The clinicopathological abnormalities reflected renal damage, in that glutamic oxaloacetic transaminase and lactic dehydrogenase increased in the urine of the dogs with clinical signs of poisoning. Serum lactic dehydrogenase was increased in dogs given 10 mg/kg citrinin. Cellular and granular casts, ketones, protein and glucose were in the urine of dogs given large doses of citrinin alone or combined with ochratoxin A. Serum concentrations of sodium, potassium and chloride in the dogs given high doses of each group.


Hepatic midzonal necrosis in a pig fed aflatoxin and a horse fed moldy hay. A 35-kg Duroc pig died 3 days after eating a ration containing aflatoxin B1, B2, G1, and G2. It had hemorrhagic enteritis and extensive midzonal necrosis in the liver. A 13-year-old Quarterhorse that died 2 days after eating moldy hay had hemorrhagic enteritis, fatty degeneration of the myocardium and renal tubules, and extensive total midzonal necrosis of the liver.


Corynebacterium equi enteritis in foals. Corynebacterium equi is a pathogen associated with respiratory disease in the foal. This paper discusses two cases of Corynebacterium equi infection, one acute and one chronic, in which the major damage was intestinal. Necrosis of Peyer's patches was the only lesion seen in the small intestine of both foals. The foal with acute disease had distinct green-tan focal necrosis and thickened mucosa of the large intestine. In the foal with chronic disease, the mucosa of the large intestine was thickened, rugose, and mottled red-tan. Histologically, the predominant lesions were villous atrophy, mucosal necrosis, mesenteric lymph node necrosis and large numbers of periodic acid Schiff (PAS)-positive macrophages filled with gram-positive pleomorphic bacilli. Electron microscopy of intestinal mucosa showed bacilli undergoing binary fission in macrophages and bacilli free in the lamina propria.


Field trials in sheep with the anthelmintic thiophanate. Productivity and tolerance trials were conducted with the anthelmintic thiophanate (Nemafax; May & Baker) in sheep in the United Kingdom. Tolerance studies, conducted in sheep of various types under several management systems, in which thiophanate was given orally at recommended dosage (50 to 100 mg/kg), or multiples thereof, in single or repeated doses showed that treatment was in all cases well tolerated. Thiophanate administered at 75 mg per kg or 250 mg per kg to groups of growing lambs with low faecal egg counts produced no post treatment depression of weight gain. When breeding ewes were treated with thiophanate at 150 mg per kg on days 14, 21 and 28 after introduction of rams to the flock, the anthelmintic produced no adverse effect on lambing performance. Trials to assess the beneficial effects of treatment were conducted in weaned lambs naturally infected with gastrointestinal nematodes. Groups of lambs were treated monthly with either thiophanate or tetramisole at recommended dosages. The two anthelmintics produced similar weight gains in the lambs and these were significantly better than those of untreated controls. In untreated controls faecal egg counts increased markedly and the clinical condition of these animals deteriorated.


[Importance of roentgeno-radioisotope diagnosis in precise determination of the TNM system classification of rectal cancer]. The authors share their experience with the use of special methods of roentgeno-radioisotope investigation (selective inferior mesentericography, intravenous pelvic phlebography, vaso-vesiculography, direct inferior lymphography, scanning of hepatic lymph nodes) for precise determination of the lesion stage in 151 patients with rectal cancer. Diagnostic findings obtained by means of selective inferior mesentericography, intravenous pelvic phlebography and vaso-vesiculography allows the division of T category to be based on the anatomical principle of the organ and adjacent tissues structure. Lymphography and lymphoscanning render it possible to pinpoint further the category NX, thus differentiating NX, N0, N1, N2. The diagnostic data obtained were carefully checked during surgical interventions and by histological assay of the operative material. The results of the work have proved the methods employed to be highly reliable.


[Determination of nitrogen, fluorine and phosphorus in osseous tissues by photonuclear activation]. A method of instrumental photonuclear activational analysis is developed for estimation of nitrogen, fluorine and phosphorus in bone tissue samples. The irradiation with maximal energy 15.6 MeV, obtained on linear accelerator of electrons LUE-25 RIMR AMN USSR, was used for activation. Estimations were carried out by the relative method with recording the intensity of positron radiation of 13N, 18F and 30P in samples and standards by means of device for gamma-gamma-coincidence. In chosen regimens of the analysis the statistical errors of nitrogen and phosphorus estimation did not esceed 1.5%, of fluorine-5%; the sensitivity of the method for nitrogen was found to be 0.06% for fluorine-0.006%, for phosphorus-0.12%; on analysis of recovery the relative standard deviation in results accounted for nitrogen-5.4%, for fluorine-6.7% for phosphorus 6.2%. Correctness in concentrations of the elements, estimated by the method described, correlated with the data, obtained in activation with reactor neutrons and with 14MeV generator neutrons.


[Complex diagnosis of early forms of cancer of the large intestine]. The complex diagnosis of early forms of cancer of the large intestine should comprise the knowledge of the clinical picture, analysis of the disease, the results of rectoromanoscopy, irrogoscopy, colonofibroscopy, and cytological diagnosis. The use of the mentioned technics would help to improve the diagnosis of early forms of colonic cancer.


[Heparin-aspirin complex, its physico-chemical and physiologic properties]. A method is developed for isolation of fibrinolytic and anticoagulant complex heparin-aspirin. The complex possessed the highest activity when the ratio of heparin to aspirin was 10 : 1. In vitro and in vivo the complex obtained showed high anticoagulant and fibrinolytic activity with respect to unstabilized fibrin both in absence and in presence of epsilon-aminocaproic acid as well as it had the thrombolytic effect on the fresh thrombus. The total fibrinolytic activity, nonenzymatic fibrinolysis and the anticoagulation activity in blood plasma were increased after chronic administration per os and after repeated intramuscular administration of the complex. The most distinct increase in fibrinolytic properties of blood occurred after intravenous administration of the heparin-aspirin complex.


[Spread of pancreatic cancer into the adjacent organs]. Observations over 250 patients with cancer of the pancreas allowed the author to present the data on metastasization and proliferation of cancer in the adjacent organs. Proliferation on the pancreatic head cancer was observed in 55.4% of patients and most frequently in upper mesenterial vessels, the portal vein, hepatic and splenic artery. In cancer located in distal portions of the gland proliferation was noted in 60% of observations, and mainly in the hepatoduodenal ligament and mesentery of the small and large intestine. Metastasization was more frequently noted both in tumor located in distal portions of the gland and in generalization of the process. Thus, cancer of distal portions of the pancreas shows a more aggressive course than cancer of the pancreatic head.


[Biogenic amines and adrenal cortical function in breast cancer]. Under study were the content of serotonin and 11-OCS in blood and diurnal excretion of 5-OIAA, adrenaline and noradrenaline in 71 pateints with breast cancer. The data obtained indicated that the examined patients, compared with the control group, show a reliably higher concentration of serotonin and 11-OCS in blood (70.4% and 19.5% correspondingly), an insignificantly increased excretion of 5-OIAA, a markedly increased diurnal excretion of adrenaline (by 96.4%), whereas a decreased excretion of noradrenaline (by 73.1%). The character of changes in the indices under study was definitely dependent on the stage of the disease (in stages 1-11 these changes were mostly pronounced), and patients' age (in young patients the adrenal cortex activity was rather intensive, whereas in aged patients biologically active substances were manifest).


[Patey mastectomy in the combined treatment of breast cancer]. Based on the findings of direct upper lymphography performed before and during the operation, the degree of radicality of the Patey surgery and radical mastectomy after the Holstead technic was studied in breast cancer patients. It has been shown that in technical respect the Patey operation is inferior in radicality to radical mastectomy and should be performed only on strict indications. It is believed that, it is not yet the time to use the Patey surgery in wide practice instead of radical mastectomy, since even the latter sometimes fails to provide the removal of all regional lymph nodes.


[Effect of insulin and steroid hormones on the conformation and activity of enzyme proteins]. An immediate effect of hormones (insulin, oxytocin, glucocorticoids and sex hormones) on the conformation and activity of enzymatically active proteins (hexokinase, glutamate dehydrogenase) was studied. Hormone-enzyme complex of insulin-hexokinase was shown to be formed. This process was accompanied by dissociation of the enzyme into two dimers without a loss of the catalytic activity but with disappearance of the property to be inhibited by glucocorticoids. The effect of insulin on the hexokinase activity was postulated to occur due to reaction of thiol-disulphide exchange between disulphide group of insulin and free sulfhydryl group of hexokinase. The inhibitory effect of sex hormones on the glutamate dehydrogenase activity was shown to be determined by their association with the enzymatically active protein. This phenomenon did not occur under conditions of stabilization of the quaternary structure of the enzyme. If the guanidine groups of glutamate dehydrogenase were blocked the inhibitory effect of sex hormones was found to decrease. These data demonstrate the importance of the guanidine groups in binding of sex hormones.


[Fast and highly-sensitive method of quantitative determination of carnosine and anserine in animal tissues]. A method is described for separation of carnosine and anserine and of the amino acids constituting them by means of thin-layer chromatography. For quantitative estimation the amino acids and dipeptides were treated with 7-chlorine-4-nitrobenzeno-2-hydroxy-1,3-diazol (NBD-chloride) and subsequently separated by chromatography on silica gel and estimated by absorption at 456-470 nm. Systems of solvents were developed for separation of both free and chemically modified amino acids and dipeptides; optimal conditions were chosen for preparation of tissue extracts and their treatment with NBD-chloride. By this method carnosine and anserine could be stimated in extract from 0.02-0.2 mg of muscular tissue. The time required for the analyses was about 3-5 hrs.


[Reasons for the untimely diagnosis of bronchial cancer]. The work deals with the study of the causes of diagnosing advanced bronchial cancer. Based on a retrospective analysis of case reports and roentgenological findings in 200 patients, it is believed to be mandatory to carry on complete roentgenological examination of patients at early stages of patients' address for medical aid, and also to take into account the topography of neoplastic process and roentgenological manifestations of different stages of impaired bronchial patency.


[Mediation of the lithium increase in rat liver tryptophan pyrrolase activity by 11-hydroxycorticosteroids]. After a single intraperitoneal administration lithium carbonate (50 and 100 mg per kg of body weight) caused an increase in the tryptophane pyrrolase activity in rat liver tissue by 50-80% within 5 hrs and did not affect the enzyme within 1, 3 and 20 hrs. Content of lithium was quite unaltered in rat blood serum after administration of lithium carbonate at a dose of 50 mg/kg; it slightly exceeded the therapeutic level at a dose of 100 mg/kg. Addition of the lithium preparation (7-10(-3)-7-10(-5) M) to liver homogenates did not change the tryptophane pyrrolase activity in vitro. The same doses of lithium (50 and 100 mg/kg) caused a 2.5-fold increase in content of 11-hydrocorticosteroids in rat blood plasma; the effect was prevented by previous administration of dexamethasone. In experiments with adrenalectomized rats lithium did not affect the enzymatic activity. Repeated administration of lithium (50 mg/kg) within 10 days did not affect the tryptophane pyrrolase activity and did not alter the content of 11-hydroxycorticosteroids in rat blood plasma. The data obtained suggest that the increase in the tryptophane pyrrolase activity, caused by lithium, is mediated through the elevation in content of 11-hydroxycorticosteroids in blood.


[Distribution of nitrazepam and its metabolites in the subcellular fractions of several white rat organs]. After intraperitoneal administration into rats at a dose of 100 mg per kg of body weight nitrazepame (mogadone, eunoktine) was enzymatically reduced with the subsequent acetylation. Derivatives of nitrazepame were found in cellular fragments and nuclei, in mitochondrial, microsomal and soluble fractions of liver, lungs, heart and brain tissues. Reduction of the substrate was shown to occur in soluble and microsomal fractions of liver tissue and acetylation--in mitochondria of lungs and liver tissue. Nitrazepame metabolites were quite uniformly distributed over cell organelles of heart and brain tissues; this suggests that they originate in the organs from other tissues, where the processes of reduction and acetylation take place. Nitrazepame and its derivatives penetrated into brain very effectively; this phenomenon is considered as an essential one for their pharmocological activity.