[Carcinoma of colostomies. Investigation on Wistar rats and clinical observations (author's transl)]. 48 surviving male Wistar rats, which achieved a double loop colostomy at the descending colon, developed spontaneous adeno-cardinomas at the proximal orifice of the stoma within 120-200 days. To differentiate the importance of fecal passage and eversion of the colon, the descending colon was separated from the fecal stream by a colostomy at the ascending colon, splitted longitudinally and inserted in the abdominal wall. Adeno-carcinoma arose in both positions, mainly within 120 days. Colonic mucosa, thus exposed, predominates to maligne transformation. The preferred development of cancer at colostomies, as seen systemically induced colonic cancer, is therefore explained to be of syncarcinogenic type. Similar lesions were found at human colostomies. The rareness of original carcinoma at human colostomies is caused by a more-years time of induction in relation to the high average age of patients getting a colostomy. In fact we regard this type of cancer as a biological phenomena comparable to the cancer of the gastric stump.


[Reversal of small bowel segments to delay intestinal passage after total colectomy (author's transl)]. Five female mini-pigs underwent total colectomy including resection of the ileocecal valve. Sparing the terminal rectum, we reformed an end-to-end anastomosis between terminal ileum and remaining rectal cuff. In a second series 8 female mini-pigs have been colectomized using the same model. To delay intestinal passage, in addition a 10-12 cm long reversed segment of terminal ileum has been inserted between small bowel and rectal stump. Both groups were compared with a group of normal unoperated mini-pigs in a study up to 1 year, observing intestinal transit time, blood chemistry and general development of the animals. It could be proved that the reversal of a small bowel segment in colectomized animals leads to a prolongation of the intestinal transit time, to normalization of electrolytes and general appearance. Colectomy was only survived by animals with a reversed segment. The clinical application of a reversed small bowel segment following total colectomy in 1 patient was successful.


Effect of a diet rich in sunflower oil on aspects of lipid metabolism in the genetically-obese rat. Aspects of the lipid metabolism of male, obese and lean Zucker rats were compared using animals which had been fed ad libitum for 32 days on a diet (HS) which contained 200 g sunflowerseed oil/kg or one (LS) which contained 50 g/kg of the oil. When compared with the LS diet, the HS diet decreased the characteristic lipid accretion in the liver of obses rats from 126 mg (LS) to 81 mg (HS)/g wet weight; corresponding values for the lean rats were 39 mg and 56 mg/g wet weight of liver, respectively. The HS diet depressed lipid synthesis de novo by liver homogenates and decreased the delta9-desaturase activity of liver microsomes from obese and lean rats by about 50%. delta9-Desaturase activity in vitro was also depressed by the addition of linoleic acid to liver microsomes from both obese and lean rats fed ad libitum on a standard laboratory diet. Depressed delta9-desaturase activity, due to ingestion of the HS diet, was reflected in lower ratios of 16:1/16:0 and 18:1/18:0 fatty acids in tissue lipids from obese and lean rats. Ingestion of the HS compared with the LS diet resulted in increased proportions of 18:2omega6 in liver lipids and adipose tissue triacylglycerols of obese and lean rats. The HS diet also increased the proportions of 20:4omega6 in adipose triacylglycerols of obese and lean rats and in liver lipids of obese animals but not in their lean littermates.


Plasma cholesterol levels in suckling and weaned kittens, puppies, and guinea pigs. Plasma cholesterol levels in kittens and puppies were low at birth, rose during the suckling period, and then decreased at about the time of weaning. The increase during the suckling period was much greater in puppies than in kittens. No significant differences in plasma cholesterol levels were observed in puppies fed two different types of diet, horse meat or dog chow, after weaning. Guinea pigs had lower plasma cholesterols than either kittens or puppies. The level was highest on the first day after birth, decreased during the next 3 wk, and then remained fairly constant after the animals were weaned.


A comparative in vivo study of intestinal absorption of biliary phosphatidylcholines and micellar phosphatidylcholines in the rat. An in vivo study was performed using rats with the purpose of comparing the absorption of native biliary and purified phosphatidylcholines. The latter were purified from bile and solubilized in the form of mixed micelles of bile salts-phosphatidylcholines-cholesterol. The animals all bore bile duct diversions, and were divided into two groups: one had a normal pancreatic secretion while in the other group the pancreatic duct was ligated. Animals with normal pancreatic secretion showed comparable rates of absorption of micellar and biliary phosphatidylcholines. In the absence of normal pancreatic secretion, the rate of absorption of biliary phosphatidylcholines was unchanged, whereas that of micellar phosphatidylcholines markedly decreased. The results are consistent with the concept that some biliary phosphatidylcholines are absorbed independently of pancreatic secretion in an unhydrolyzed form.


Hypertriglyceridemia in Ehrlich ascites carcinomatous mice: tumor and mouse strain differences. Ehrlich ascites carcinoma growth in mice induces hypertriglyceridemia. The degree of hypertriglyceridemia found in one laboratory (Spector's) was much greater than we observed in our laboratory. Moreover, major differences were reported with respect to fasting (no effect on tumor extracellular fluid triglyceride levels in Spector's tumor-bearing mice; marked decrease in ours). We have obtained tumorous CBA mice from Spector's laboratory and have studied them simultaneously with our Swiss-Webster mice. Triglyceride levels of the above two groups and from two controlled crossover groups, included to evaluate the influence of mouse and tumor strains on hypertriglyceridemia, were determined. The CBA mice had intense hypertriglyceridemia and high triglyceride levels in tumor extracellular fluid regardless of the subline source of ascites tumor. On the other hand, only mild hyperlipidemia was induced with both strains of tumor in Swiss-Webster mice. Thus, the variations in plasma and tumor extracellular fluid triglyceride levels probably arise from the mouse strains and not from variations in the tumor subline. Fasting caused a decrease in both plasma and tumor extracellular fluid triglyceride concentrations in CBA, as well as in Swiss-Webster mice. A mouse strain difference was also evident from a significant decrease in wet weights of adipose tissues like epididymal fat, inguinal fat, and intermuscular fat with tumor growth in the CBA strain which was not observed in the Swiss-Webster strain at the corresponding stage of tumor growth. Study of these strain diffeences may lead to an understanding of factors that regulate hyperlipidemia.


Changes in the acyl and alkenyl group composition of cardiac phospholipids in boars fed corn oil or rapeseed oil. Boars fed diets containing rapeseed oil for 8 weeks showed significantly higher levels of neutral lipids and similar levels of phospholipids, compared to those fed corn oil. Erucic and eicosenoic acids were found to be high in ethanolamine phosphoglycerides, and in particular alkenyl acyl-ethanolamine phosphoglyceride. Furthermore, both long chain monoenes were incorporated preferentially in position 2 of the choline and ethanolamine phosphoglycerides. The alkenyl group composition of the cardiac lipids of pigs was influenced by dietary fatty acids. When rapeseed oil was fed, small amounts of 20:1 and 22:1 alkenyl constituents were detected.


Lipid and fatty acyl composition of rat brain capillary endothelia isolated by a new technique. A method is described for the isolation of pure capillary endothelia from rat brain and the phosphlipid composition of these cells is reported. This method is rapid and requires only a small amount of starting material. It involves: (a) tissue disruption by high speed homogenization, (b) separation of the capillary endothelia from other brain structures using sucrose gradients, and (c) a final purification using a glass bead column. Choline and ethanolamine phosphoglycerides were found to be the predominant lipid classes of these cells amounting to 31.9% and 24.4%, respectively, of total phospholipids. The choline phosphoglycerides consisted almost exclusively of 1,2-diacyl glycerophosphorylcholine, whereas the ethanolamine phosphoglycerides consisted of approximately equal amounts of 1,2-diacyl and 1-alk-1'-enyl-2-acyl glycerophosphorylethanolamine. The composition of the constituent fatty acids of both choline and ethanolamine phosphoglycerides and the alk-1-enyl composition of ethanolamine phosphoglycerides is reported. Saturated fatty acids accounted for 45% of the total fatty acids in choline phosphoglycerides and for 53% in ethanolamine phosphoglycerides. Arachidonic acid accounted for approximately 48% of the total fatty acids in alk-1-enyl ethanolamine phosphoglyceride.


Potential for employing the distribution of anomalous non-methylene-interrupted dienoic fatty acids in several marine invertebrates as part of food web studies. A group of homologous, nonmethylene-interrupted dienoic fatty acids (NMID) recently reported in oysters has been found in several other shellfish species and also in other marine phyla. The distribution of most other "normal" fatty acids among several species of shellfish is basically similar but mantle lipids from two other molluscan species, both squid, differ radically. The squid mantle fatty acids do not include NMID, suggesting that in molluscs NMID may accumula-e primarily in filter-feeders or herbovores. The distribution of these anomalous fatty acid components in higher species suggests that they reflect invertebrates in the diet and are biochemically inert.


Studies on long chain cis- and trans-acyl-CoA esters and Acyl-CoA dehydrogenase from rat heart mitochondria. The beta-oxidation of long chain fatty acids was investigated in a preparation of rat heart mitochondria. The acyl-CoA esters of the cis and trans isomers of delta9-hexadecenoic, delta9-octadecenoic, delta11-eicosenoic, and delta13-docosenoic acids were prepared. Rates of the acyl-CoA reaction were determined with an extract from rat heart mitochondria. The apparent Michaelis constant (Km) and maximum velocity (Vmax) were calculated for each substrate. In general, apparent Vmax values decreased with increasing chain length of the monoenoic substrates. Reduced activity of acyl-CoA dehydrogenase with long chain acyl-CoA esters could have contributed to accumulation of lipids in hearts of rats fed diets containing long chain fatty acids.


Ether-linked glycerolipids in human brain tumors. In this investigation, the lipid composition of a number of human brain tumors was determined and compared to that of normal adult brain. Glioblastomas (11 samples), astrocytomas (4 samples), an acoustic neurinoma, an oligodendroglioma, and a meningioma were analyzed. All of the tumors had substantial levels (0.8-3.4% of total phospholipids) of choline plasmalogen which was present in only trace amounts in normal brain. With the exceptions of the acoustic neurinoma and the meningioma, the concentration of alkylacylglycerophosphorylcholine was also higher in the tumors than in normal brain. Neutral lipids of brain tumors also contained high concentrations of both alkyl (1.6-4.8% of total neutral gsults from this investigation indicate that increases in ether-linked glycerolipids may be characteristic of human brain tumors.


The effect of lipids on taurocholate absorption from intestinal loops in the rat. The rates of uptake and serosal transfer of [14C]-labelled taurocholate (7.77 mM in bicarbonate buffer, pH 6.5) were determined in situ in ligated segments of rat intestine in the presence of lipids. Oleic acid, monoolein, lecithin, and lysolecithin enhanced taurocholate uptake and transfer in the jejunum, each lipid exhibiting an optimal concentration at which the bile acid fluxes were maximal. The maximal rates of bile acid uptake observed with the various lipids were close to four times the uptake rates found with the lipid-free taurocholate medium, whereas serosal transfer rates under optimal conditions were enhanced about six-fold. The optimal concentrations differed widely among the various lipids, being inversely related to the lipids' polarity. Simultaneous measurement of taurocholate and [3H]-labelled oleic acid showed that under optimal conditions, when the molar concentration of oleic acid was about equal to that of the bile acid, the fatty acid and bile acid also exhibited closely similar rates of absorption. At other fatty acid concentrations, the fractional rate of absorption of the bile acid was much lower than that of the fatty acid. The rates of uptake and serosal transfer of pure taurocholate by the ileum exceeded those of the jejunum by factors of about 7 and 15, respectively, but in the presence of lipids this difference in absorptive capacity for bile acid between the distal and proximal segment largely disappeared.


Tissue variation in hydrocarbon composition in the rabbit. This study, which deals with the distribution of hydrocarbons in seven types of rabbit tissues, was done for the purpose of providing information that might help shed light on the biological relevance of the hydrocarbons in mammalian metabolism. Liver, kidneys, brain, spleen, skeletal muscle, perinephric adipose, and a sample of blood serum were collected from a single animal for analysis of their hydrocarbon composition. The analytical methodology consisted of solvent extraction, saponification (adipose), elution chromatography on hydrated alumina, and combined gas chromatography-mass spectrometry. Hydrocarbons were detected in all of the tissues examined at concentrations estimated to range from 0.1 to 0.01% of the total lipid extracted Three quite distinct distribution modes were recognized. The bulk of the identified components consisted of normal, saturated, nonterpenoid hydrocarbons in the C16 to C33 range. Squalene, phytene, phytadiene, and pristane were the only terpenoids detected. Nonterpenoid branched (iso and anteiso) hydrocarbons were identified unequivocally and in significant amounts in the muscle only. The adipose was the only tissue which was relatively rich in monoalkenes, and its overall hydrocarbon composition closely resembled that of the feed. The results of the study are not consistent with metabolic inertness. The observed qualitative and quantitative differences might reflect function and metabolic activities of the individual organs in a way yet to be elucidated.


Characterization of bovine rumen liquor isoprenoid hydrocarbons with reference to dietary phytol. The isoprenoid hydrocarbon, trans-phyt-2-ene (82.2%), phyt-1-ene (6.5%), and phytane (11.3%), were detected in bovine rumen liquor by means of AgNO3-impregnated thin layer chromatography and gas liquid chromatography with mass spectrometry and infrared spectrophotometry. The unsaturated hydrocarbons were identified by comparing their chromatographic, physical, and chemical properties with those of synthetic isoprenoid hydrocarbons prepared from dihydrophytol. The natural level of the original isoprenoid components within the rumen is comprised of phytol and dihydrophytol (of the ratio of 2:1). These represented at least 60% of the total free fatty alcohol content of the rumen liquor lipid extract and could, therefore, be the origin of the isoprenoid hydrocarbons observed.


Lipid metabolism in plasma, liver, and adipose tissue of rats with experimental chronic nephrotic syndrome. Plasma, liver, and adipose tissue lipid composition and synthesis from [1-14C] acetate were studied three months following induction of nephrotic syndrome in rats by injection of antiglomerular basement membrane protein. Plasma triglyceride concentrations and specific radioactivities were elevated, and the triglycerides contained increased proportions of oleic acid. Plasma cholesterol and phospholipid concentrations were also increased, but free fatty acid levels were not. Liver triglyceride concentrations were decreased and incorporation of [1-14] acetate into liver triglycerides was also depressed below that of normal controls. Nephrotic rat liver triglycerides contained a higher proportion of oleic acid and lower arachidonic acid than did controls. Incorporation of [1-14C] acetate into adipose tissue lipids of the nephrotic rats was increased, and the proportion of palmitic acid was decreased. In the chronic nephrotic rat, the major source of the increased plasma triglycerudes may be fatty acids mobilized from adipose tissue stores.


The effects of original and randomized rapseed oils containing high or very low levels of erucic acid on cardiac lipids and myocardial lesions in rats. The nutritional status of the very lowerucate, rapseed oil, Brassica napus var. 'Tower,' was compared with that of the high-erucate oil, Brassica napus var. 'Target,' as well as with corn oil. The effect of randomization on the nutritional qualities of rapeseed oil was investigated as well. The feeding of diets containing the original and randomized 'Tower' oil or the original 'Target' oil, at the 20% level by weight, gave growth rates which were not significantly different from that for corn oil. However, the randomized 'Target' oil gave growth rates which were significantly less than all other groups. The growth results could not be explained simply on the basis of food consumption. The level of triglycerides in the hearts of rats fed the very low-erucate oils was not significantly different from the corn oil group. Triglyceride concentrations in the hearts of animals given the high-erucate oils were 7-12 times greater than all other groups. The level of total fatty acids in tissue phospholipids was the same regardless of dietary treatment. Fatty acid compositions of the tissue lipid were the same in animals fed either the original or randomized rapeseed oils. A much higher incidence of focal myocardial necrosis was found in animals receiving high-erucate rapeseed oil relative to animals given the corn oil. The incidence in rats fed diets containing very low-erucate rapeseed oil was intermediate between these latter two extremes.


Gas chromatographic separation of cholesteryl esters of fatty acids of different degrees of unsaturation. Cholesteryl esters prepared from the fatty acid methyl esters of linseed oil, pig liver lipids, and Japanese anchory oil have been separated on the basis of their chain lengths and number of double bonds by gas liquid chromatography on a cyanosiloxane SILAR 10C column. The equivalent chain lengths of cholesteryl esters having acyl groups with 14-22 carbons and 0-6 double bonds are presented. A significant influence of the column temperature on the equivalent chain lengths of the polyenoic fatty acid cholesteryl esters has been found. Separation of the cholestanyl and epicholestanyl esters of linseed oil fatty acids, respectively, under the same conditions is also described.


Absence of eicosatrienoic acid in plasma of sheep parenterally infused with a high glucose fat-free solution. Five yearling wether sheep were maintained on total intravenous, fat-free feeding for periods in excess of 4 weeks. Analysis of plasma total lipid, neutral lipid, and phospholipid fatty acid patterns showed a decrease in linoleic acid during the first week, after which levels tended to stabilize. Rate of decrease in linoleic acid content of plasma phospholipids of two sheep was different. Changes in nonessential fatty acids were variable. 5,8,11- and 8,11,14-Eicosatrienoic acids were not detected in any of the sheep.


Glycerol ester hydrolase activity in the pulp of unerupted calves' teeth. The pulp from unerupted calves' teeth was found to contain low levels of glycerol ester hydrolase activity. Solutions in Tris buffer cleared tributyrylglycerol agar and hydrolyzed emulsified olive oil. The average quantity of free fatty acids released in five assays with olive oil was: 2.8, S.D.+/-1.4. Specific activities were: 0.25, S.D.+/-0.13, mkatals/kg protein.


Action of three bile acids on hepatic and intestinal cholesterogenesis in the rat. Incorporation of [1(14)-C] acetate into cholesterol by subcellular particles from the liver and the small intestine of rats with a biliary diversion and a duodenal perfusion of sodium taurocholate, taurochenodeoxycholate or taurodehydrocholate, was studied in vitro. In the liver, taurochenodeoxycholate prevented the increase of cholesterol synthesis induced by biliary drainage. Taurocholate had no action on cholesterol synthesis at any time, day or night. Intestinal synthesis of cholesterol was reduced by taurocholate and taurochenodeoxycholate but was not modified by taurodehydrocholate infusion.


Tissue lipid responses to 3-hydroxy-3-methylglutaric acid with different dietary fats. Simultaneous administration of 3-hydroxy-3-methylglutaric acid (HMG) for 4 weeks to rats fed 20% saturated fats prevented rise of serum cholesterol, triglycerides, and phospholipids. Except phospholipids, other liver lipids were significantly decreased. HMG administration for 4 weeks along with atherogenic diet significantly decreased cholesterol and phospholipids of serum, liver, aorta, and heart. The phospholipids of epididymal fat and brain were also significantly lowered. The triglyceride levels in serum, liver, and epididymal fat were significantly decreased. The maximal hypolipidemic effect of HMG was observed in serum.


Serum and liver lipid responses to 3-hydroxy-3-methylglutaric acid in rats on different carbohydrate diets. Groups of male adult albino rats were administered 3-hydroxy-3-methylglutaric acid (HMG) intraperitoneally along with six diets differing only in the type of carbohydrate used. Groups not treated with HMG served as controls. HMG showed a significant cholesterol- and tri-glyceride-lowering effect in the whole serum, serum beta-lipoproteins, and liver of animals on all types of dietary carbohydrates. The effect was more marked in glucose, fructose, sucrose, and lactose. The phospholipid levels in whole serum, serum beta-lipoproteins, as well as in liver were also significantly lowered on all types of carbohydrates except dextrin and starch fed animals, where it had no effect on liver levels. The lipid-lowering effect of HMG seems to be independent of the type of carbohydrate in diet.


Composition of novel triesters from the skin of the rhino mutant mouse. Composition of two novel triesters, derived from the skin of the rhino mutant mouse, is described. Chemical and spectroscopic analysis of the products of pancreatic hydrolysis of the triesters showed that these are comprised predominantly of isomer I (92.7 mole %). The syntheses of two reference compounds, I-O-hexadecanoyl-2-[(14-hexadecanoyloxy)O-tetradecanoyl] 1,2-hexadecanediol (Ia) and 2-O-hexadecanoyl-1-[(14-hexadecanoyloxy)-O-tetradecanoyl]-1,2-hexadecanediol (IIa), corresponding in their structures to isomers I and II of the triester, wax have also been described.


Titration of sterol double bonds with dibromopyridine sulfate. Cis and trans-22-dehydrocholesteryl acetates and cis and trans-22-cholesten-3beta-yl acetates were prepared and compared to delta22-phytosterylacetates by titration with dibromopyridine sulfate. The cholesterol derivatives absorbed close to the theoretical quantity of bromine (1 Br2 per double bond), whereas the delta22-C24-alkylated sterols consumed 0.14 to 0.23 Br2 in excess of the calculated values. This excess is attributed to the formation of additional unsaturation during bromination. delta7 and delta8(14)-sterols consume more than 2 and 3 moles Br2, respectively, which indicates that at least one or two new double bonds are formed in these molecules during the bromination step.


Changes in rat heart phospholipid composition after rapeseed oil feeding. The influence of long duration rapeseed oil feeding with high or low levels of erucic acid has been investigated on rat heart phospholipids. The rats treated for 20 wk with rapeseed oil containing 46.2% erucic acid showed a twofold increase in the sphingomyelin content of the heart. Treatment with primor rapeseed oil (3.7% erucic acid) for 20 wk did not modify phospholipid composition of rat heart. The fatty acid patterns of phosphatidylethanolamine and phosphatidylcholine were slightly influenced by the high erucic rapeseed oil; eicosenoic acid was incorporated preferentially into position one, but erucic acid showed a random distribution in both. After high erucic rapeseed oil feeding, 22:1 was incorporated into cardiolipin (5.6%) and sphingomyelin (10.5%). The incorporation of 22:1 into sphingomyelin was associated with an increase of the percentage of 24:1 (14.6%) and a decrease of saturated long chain fatty acid (22:0, 24:0) percentages. Primor rapeseed oil caused a slight increase of 24:1 and a decrease of 22:0 and 24:0 in rat heart sphingomyelin. As cardiolipin is localized in the inner membrane of mitochondria and sphingomyelin in plasma and microsomal membranes, the acyl-moiety alterations of both phospholipids might be correlated to the pathological lesions of rat heart after a long duration of rapeseed oil feeding.


Positional isomers of unsaturated fatty acids in rat liver lipids. The fatty acids of liver lipids from rats raised on a fat free diet from the 30th to the 90th day after birth were analyzed with special regard to the detection of positional isomers of mono-, di-, tri-, and tetraenoic fatty acids. The methyl esters obtained after transesterification of total lipids were separated by argentation chromatography into five fractions: I saturated, II monoenoic, III dienoic, IV dienoic nonmethylene interrupted, V tri- and tetraenoic fatty acid esters. After hydroxylation of the double bonds with osmium tetroxide, the analysis of the poly-O-trimethylsilyl derivatives by gas liquid chromatography on S.C.O.T. columns combined with mass spectrometry revealed the presence of 19 monoenoic, 15 dienoic, and 9 trienoic as well as 3 tetraenoic fatty acid isomers including the normally occurring representatives of the (n-3), (n-6), (n-7), and (n-9) fatty acid families. The majority of the identified isomers can be coordinated to one of these families like 7-16:1; 11-20:1; 6,9-18:2; 8,11-20:2; 5,11-20:2; 5,8,11-20:3; 7,10,13-22:3 to the (n-9) family, 11-18:1; 13-20:1; 5,11-18:2; 7,13-20:2; 6,11-18:2; 6,9-16:2; 8,11-18:2; 10,13-20:2; 5,8,11-18:3; 7,10,13-20:3; 4,7,10,13-20:4 to the (n-7) family and 11,14-20:2; 5,11,14-20:3; 6,9,12-18:3; 8,11,14-20:3; 5,8,11,14-20:4; 7,10,13,16-22:4 to the (n-6) family. All these naturally occuring isomers can be placed into a network of desaturation and chain elongation steps which allows certain conclusions about the substrate specificity of the delta6-, delta5- and delta4-desaturase systems. The great number of isomers found in the (n-7) family indicates that the members of this family are actively metabolized in partial essential fatty acid deficiency.


Differential biosynthesis of molecular species of 1,2-diacyl-sn-glycerols and phosphatidylcholines in cold and warm acclimated goldfish (Carassius auratus L.). The initial incorporation of glycerol-3H into the molecular species of liver 1,2-diacyl-sn-glycerols and phosphatidylcholines was studied in vivo using goldfish acclimated to 10 C and 30 C. A 1.5- and 2.2-fold higher proportion of the total radioactivity in the diacylglycerols from cold acclimated fish was found to be associated with the trienoic and pentaenoic species, respectively, when compared to warm acclimated fish. In the phosphatidylcholines, 1.9- and 1.3-fold greater percentages of the newly-incorporated radioactivity were found in tetraenoic and pentaenoic molecules, respectively, from cold relative to warm acclimated fish which suggests a preferential synthesis of these molecules relative to other molecular species in response to a lowering of environmental temperature. The present results indicate, therefore, that environmental temperature influences the complement of molecular species of diacylglycerols an phosphatidylcholines which fish produce by way of de novo biosynthesis in vivo.


Sterol composition and phytosterol utilization and metabolism in the milkweed bug. Analysis of the sterols of the milkweed bug, Oncopeltus fasciatus (Dallas) and dietary sunflowerseeds revealed that there is little, if any, conversion of dietary C28 OR C29 phytosterols to cholesterol in this phytophagous insect. The dietary sterols are apparently utilized with little alteration both during development to the adult stage and egg production, and cholesterol comprises less than 1% of the sterols in either adult males and females or in the eggs. The significance of these findings are discussed in light of the recent discovery that the C28-ecdysone, makisterone A, is the predominant molting hormone inthe embryonated egg of the milkweed bug.


Cystic fibrosis: a new outlook. 70 patients above 25 years of age. We have presented a group of 70 patients over 25 years of age as of January 1, 1975, who were diagnosed as having cystic fibrosis (CF) at various ages from birth to 28 years. Some patients were diagnosed late in life in spite of classical symptoms and a characteristic history of the disease. Patients with CF present with a broad spectrum of symptoms which vary considerably in severity. This older age group represents approximately 10% of our current roster of patients with CF. This disease is no longer confined to early life and will continue to be seen with increasing frequency in older patients. Our experience with this disease indicates that a number of affected individuals can attain adulthood and find a useful place in society. The quality of life provided to these adults is illustrated in their intellectual, socioeconomic achievements and marital life. Our aim has been to recognize the disease as early in life as possible and to provide a comprehensive medical program which includes all aspects of health care.


The pseudothrombophlebitis syndrome.

The pseudothrombophlebitis syndrome. Sixty-two patients with popliteal or calf synovial cysts defined by arthrography are presented, of whom 34 had the pseudothrombophlebitis (PTP) syndrome. While the clinical manifestations of PTP may closely mimic thrombophlebitis, including the presence of calf pain, swelling and warmth, and a positive Homans' sign, the helpful descriminating features include the presence of inflammatory joint disease (91%), concomitant pain and swelling of the knee (94%), a demonstrable knee effusion (91%) and the absence of deep venous tenderness or cord. Except for seven patients with large intact Baker's cysts, the PTP syndrome was associated with synovial cyst dissection (18 patients), rupture (5 patients), or both (4 patients). Of those with arthrographically demonstrated Baker's cysts, only 27 (44%) had a palpable mass in the popliteal fossa and another 4 (12%) a mass in the calf. Popliteal fossa pain was noted in 22 (35%). Thus, clinical features are far less sensitive than arthrography in the diagnoses of both synovial cysts and pseudothrombophlebitis. Among patients with rheumatoid arthritis there were no differences in the severity or duration of disease or the extra-articular features in patients with and without synovial custs or the PTP syndrome. The therapeutic implications of pseudothrombophlebitis are of major significance with respect to the avoidance of anti-coagulation and the prompt response to intra-articular corticosteroids. Possible mechanisms of synovial cyst formation and unusual presentations of synovial cysts are discussed, and the literature is reviewed.


The assessment of diaphragm function.

The assessment of diaphragm function. Paralysis or severe weakness of the diaphragm (the principal muscle of inspiration) is commonly associated with hypoventilation which may be profound during sleep, but the disorder is often unrecognized. The clinical sign of paradoxical (inward) movement of the abdominal wall during spontaneous inspiration in the supine posture may be overlooked, or the appearances at fluoroscopy may mislead, for it is not generally appreciated that descent of the diaphragm in early inspiration in these patients may be an entirely passive event. Measurement of transdiaphragmatic pressure is a simple, reliable and quantitative means of assessing diaphragm function, and will aid in the diagnosis of diaphragm paralysis which has important implications for clinical management.


Infections with Acinetobacter calcoaceticus (Herellea vaginicola): clinical and laboratory studies. In a retrospective review of 53 patients, 58 episodes of infection due to Acinetobacter calcoaceticus var. anitratus (Herellea vaginicola) were studied. Although the organism is widely distributed in nature, it is of relatively low virulence since colonization is more frequently noted than infection and since most infections occur in patients subjected to the epidemiologic pressures common to nosocomial, gram-negative bacillary infection: prior antibiotic therapy; instrumentation and manipulation (e.g., endotracheal intubation, urinary bladder catheterization, arterial and venous cannulation); surgery; hospitalization, especially with residence in an intensive care unit; severe underlying disease, either systemic (e.g., chronic obstructive pulmonary disease, malignancy) or localized to the infected area (e.g., prior bacterial or aspirational pneumonia, trauma). Pneumonia was the most common infection due to A. calcoaceticus, and occurred only in patients with a tracheostomy or endotracheal tube in place. In over half the 25 patients, more than one lobe was involved and bronchopneumonia was the usual roentgenographic appearance. Cavitation (2 patients) and empyema formation (3 patients) were uncommon. The severity of acinetobacter pneumonia is reflected in the high mortality rate (44% overall, with a 36% mortality rate due primarily to infection). Tracheobronchitis due to A. calcoaceticus was less severe than pneumonia since no patients died primarily as a result of the infection. Urinary tract infections occurred in five patients, none of whom were ill and none of whom died. Urinary bladder catheterization was thought to be responsible for infection in three patients, and in at least four of the five patients infection was restricted to the lower tract. Wound infections were noted in six patients who had undergone surgery and were related to the presence of foreign bodies in the operative site in five of the patients. Surgical debridement and/or drainage of the infected area was the primary therapeutic measure employed in most cases. Only one patient died and this was a result of noninfectious causes. Skin infection due to A. calcoaceticus was seen in two patients, one of whom exhibited fulminant, fatal cellulitis and septicemia in the setting of pancytopenia. All nine patients with acinetobacter septicemia had received antecedent antibiotic therapy, and in all cases intravenous catheters were in place at the time bacteremia occurred. Clinically, seven of the nine patients were in shock. The mortality rate was 44% overall, with a 22% mortality rate due to infection. Although septicemia was thought to be "line-related" in five of the nine patients, serious post-bacteremic complications developed in three patients: prosthetic valve endocarditis, suppurative thrombophlebitis and subhepatic abscess.


Haemophilus parainfluenzae infective endocarditis. Seven young to middle-aged patients with Haemophilus parainfluenzae endocarditis are reported. Three patients had underlying heart disease and three patients had recent events predisposing for endocarditis. The clinical presentation was subacute or acute and new pathologic murmurs were uncommon. Diagnosis was prolonged because of difficulties in isolating the organism. Routine subculturing of blood cultures to chocolate agar with incubation in CO2 is recommended. A prominent complication, occurring in six patients, was major arterial occlusion secondary to emboli. Antibiotic control of infection was difficult and best achieved by the concomitant administration of ampicillin and gentamicin. Killing curves proved useful in assessing antibiotic efficacy. There were two medical failures and one death in the series. It appears H. parainfluenzae endocarditis is characterized by distinctive clinical features, difficult in vitro isolation of the organism, and the necessity for combination antibiotic therapy.


Urinary excretion of carnitine in patients with hyperthyroidism and hypothyroidism: augmentation by thyroid hormone. Urinary excretion of carnitine and serum concentrations of carnitine, triglyceride, and free fatty acids were measured in 54 hyperthyroid and 13 hypothyroid patients, and the results were compared with those of normal subjects. In hyperthyroid patients urinary excretion of carnitine was highly increased above that of the control subjects. On adequate treatment with antithyroid drug, carnitine excretion was reduced to the normal range, and serum lipids changed in parallel. In contrast, carnitine excretion was markedly reduced in hypothyroid patients. After substitution therapy with thyroid hormones the excretion increased in these patients. This change was associated with a marked reduction of serum triglyceride. There was an inverse correlation between urinary excretion of carnitine and serum triglyceride concentration. Carnitine excretion was significantly correlated with serum thyroxine concentration in hyper- and hypothyroid patients. The results suggest that thyroid hormones play an important role in carnitine metabolism, which in turn influences serum triglyceride metabolism.


Spontaneous activity and adipose cellularity in the genetically obese Zucker rat (fafa). The development of spontaneous activity was studied in obese and lean Zucker rats. Rats were given access to activity wheels for 3 hr/day before weaning and for 24 hr/day after weaning. Zucker obese rats are less active than lean rats. This decreased activity occurs at weaning and follows the onset of hyperphagia and obesity. At 8 wk of age exercised lean and obese rats have less total fat and fewer adipocytes than their appropriate controls. Adipose cell size is decreased only in exercised lean rats. When rats are exercised until 8 wk of age and then confined until 6 mo of age, body weight and fat is elevated in these formerly active rats compared to control rats. Adipose cell number is permanently decreased only in formerly active lean rats. Exercise has no long-term effect in decreasing cell number in obese rats.


Alpha-adrenergic control of growth hormone release during surgical stress in man. The mechanisms involved in the initial release of growth hormone (GH) during cholecystectomy have been studied after the administration of phentolamine in saline and in isotonic glucose, and after the administration of 10% glucose. Infusion of these substances was started 10 min before and terminated 30 min after skin incision. The serum GH levels 30 min after skin incision in a nontreated control group were raised to 14.4 +/- 1.0 ng/ml. The alpha-adrenergic blockade by phentolamine (20 mg during 40 min) regardless of whether administered in saline or in isotonic glucose inhibited GH response to surgery (4.3 +/- 2.1 ng/ml, or 2.2 +/- 0.4 ng/ml). The administration of 10% glucose (40 g during 40 min) led to a diminished response in some, but not in all the patients (6.2 +/- 1.2 ng/ml). It is concluded that the alpha-adrenergic mechanism participates in GH response to surgery.


"Blow-in" fracture of the orbit with partial visual loss and choroidal folds. Choroidal fold formation caused by "blow-in" fracture of the orbit is described. Rapid and almost complete recovery of vision followed removal of the bone fragments compressing the globe. The findings in this case support the conclusions of recent animal experiments on the pathogenesis of choroidal folds. Congestion of the choroid and adhesions to Bruch's membrane are probably prerequisites for folds to form, and folds are aligned perpendicular to a force applied to the eye.


Multilobular biliary cirrhosis of the liver associated with cystic fibrosis (mucoviscidosis). A case (including autopsy findings) is reported of multilobular biliary cirrhosis with a strictly nodular liver developing in a 20-year-old male with cystic fibrosis (mucoviscidosis). The pathogenesis of biliary cirrhosis in cystic fibrosis is briefly discussed.


The role of a coordinator of postgraduate studies. I commenced duties as coordinator of Postgraduate Studies at the Royal Perth Hospital on January 1, 1975, and now give an account of what I believe were the problems which led to my appointment and continue by outlining my plan of action. I then express an opinion as to what sort of person should undertake such a role in postgraduate medical education and conclude by giving brief details of the performance expected from such a person.


A critical examination of the insertion of intravenous cannulae. Insertion of intravenous cannulae initially constitutes a technical challenge to medical students and doctors alike, but mastery of the mechanics of insertion and the commonness of the procedure has often resulted in complacency with regards attention to asepsis. Attention is drawn to several fundamental areas of inadequacy.


Clonazepam in cranial neuralgias.

Clonazepam in cranial neuralgias. A study of 21 patients has shown that clonazepam is an effective drug in preventing attacks of pain in trigeminal neuralgia and Sluder's syndrome. It has also been shown that no side effects result from long-term prescription of this drug.


Motor cycle helmets and facial injuries. The design of motor cycle helmets has been changing over the years and at the present time there are two basic types in popular use: "full-face" and "jet" helmets. Both helmet types give good protection to the brain, but, one would think, different degrees of facial protection. A special study of traffic crashes has indicated that full-face helmets provide significantly greater protection against facial injury than do jet helmets. The study also indicated that the wearers of full-face helmets have no greater risk of involvement in road traffic crashes than do the wearers of jet helemts. It is suggested that the use of full-face helmets should be encouraged and consideration given to the revision of helmet standards to require the provision of facial protection.


Sudden death from ischaemic heart disease: a review of five hundred consecutive cases. The history and autopsy findings in 500 cases of ischaemic heart death investigated by the Perth City Coroner were examined. Pathology evidence of myocardial infarction was present in 105 cases (21%) and of coronary thrombosis in 108 cases (21-6%). The only structural pathological abnormality leading directly to death was cardiac rupture with tamponade, which occurred in 25 cases (5%). Strenuous exercise was directly associated with the onset of fatal symptoms only rarely (in 7% of cases). These findings indicate that functional rather than structural abnormalities are the major cause of death in ischaemic heart attacks.


Drowning and near-drowning in the Australian Capital Territory: a five-year total population study of immersion accidents. A total population study of all serious immersion accidents is reported from the Australian Capital Territory. The annual immersion accident rate of 4-69 per 100,000 of the population at risk is low, and the fresh water fatality rate of 2-58 per 100,000 is very low. The annual fatality rate for childhood swimming pool accidents is 0-34 per 100,000 children (that is, under 16 years of age) at risk. Serious immersion accidents are not increasing in frequency, in striking contrast to the epidemic trends seen from other centres. Factors which might explain this are discussed.


Motor-car accidents during pregnancy.

Motor-car accidents during pregnancy. Motor-car accidents in the State of Victoria in the years 1973 to 1975 inclusive resulted in five maternal and 27 fetal deaths. Severe maternal injury only occurred in women not wearing seat belts; however, fetal death may well have been due to seat belt injury in 14 subjects. The commonest genital tract injury was placental abruption.. However, uterine rupture was observed on three occasions and these cases are described in detail.


The place of Dwyer anterior instrumentation in scoliosis. The technique of Dwyer instrumentation and fusion has now become estabilished as having a definite place in the surgery of scoliosis. It is complementary to the Harrington technique of posterior instrumentation and fusion. The latter is especially suited to thoracic and double scoliotic curves, while the particular indication of the Dwyer method is the lumbar curve. Thoracolumbar curves maybe treated by either method, and paralytic curves are often best handled by a combination of the two. A significant element of kyphosis constitutes an absolute contraindication to the Dwyer procedure.


Marihuana and driving hazards.

Marihuana and driving hazards. Recent research indicates that cannabis use is positively associated with the road toll. In controlled laboratory studies it has also been shown to adversely affect perception skills, coordination, braking time and other motor skills, mood, judgement, and so on. In driving studies (in both controlled areas and ordinary traffic) marihuana adversely affected driving safety. The literature on cannabis is diffused over international journals covering a wide range of specialities--this paper draws together the evidence from 22 scientifically valid reports. A report on a 1975 conference on drugs and driving is described.


Bathtub immersion accidents involving children. A review of 19 consecutive serious bathtub immersion accidents (11 survivals, 8 fatalities) is presented. In all instances, consciousness was lost in the water. Unlike other childhood accidents which usually show a male predominance, the sexes are equally affected. The modal age is 11 months. Six separate causes of bath drownings and near-drownings have been identified, and in 14 of the 19 accidents, two or more causes were operating concurrently. Median estimated immersion time for survivals was four minutes, and five minutes for fatalities. The median depth of water was eight inches. An 'at risk' profile for home bathtub drownings is presented; this includes the youngest or second youngest child of a large family, a family of grade 4 to 7 sociooccupational status (congalton) and a family in which routine is temporarily broken.


A role of frusemide in resistant hypertension. Five patients who were resistant to their antihypertensive drug therapy were admitted to hospital. Four had marked falls in blood pressure and an associated loss of weight. This fall in blood pressure was able to be repeated outside hospital by adding frusemide to their other drug therapy. Certain hypertensive patients become resistant to their antihypertensive therapy, owing to the accumulation of sodium. Thiazides may not have sufficient natriuretic properties to correct this accumulation. In these circumstances, frusemide may allow the hypertension to be controlled.


[Clinical aspects of pulmonary arteriovenous fistulas (author's transl)]. 3 patients with a congenital pulmonary arteriovenous fistula are presented. The clinical signs of this condition are dependent on the size of the functional right to left shunt. The symptoms worsen with increasing arterial hypoxemia. Due to the hemodynamics of arteriovenous fistulas signs of cardiac hypertrophy are usually not seen on ECG of X-ray examination. However, in almost all cases pulmonary X-ray shadows are found. In addition, nearly 50% also have an hereditary hemorrhagic telangiektasis. The diagnosis must be verified in every case by cardiac catheterisation with angiography, since only exact anatomic data can give precise information on whether or not an operation is possible.


Increased DNA polymerase and ATP-dependent deoxyribonuclease activities following DNA damages in mycobacterium smegmatis. Treatment of growing cultures of Mycobacterium smegmatis with alkylating agents (methyl methanesulphonate, ethyl methanesulphonate, nitrogen mustard, or mitomycin C) or with ultraviolet light resulted in enhanced specific activities of a DNA polymerase and of an ATP-dependent deoxyribonuclease. Similar results had previously been obtained with hydroxyurea and with iron limitation. The three of these treatments which were tested (methyl methanesulphonate, mitomycin C and hydroxyurea) produced strand breaks or alkali-labile regions in the DNA of this organism. The increased enzyme activities could be prevented by simultaneous treatment with inhibitors of protein synthesis. In contrast, treatment of the cultures with intercalating agents (ethidium bromide, acridine orange, or proflavine), 5-fluorouracil, caffeine, or nalidixic acid, inhibited DNA synthesis without increasing the enzyme activities. These treatments did not produce strand breaks in the DNA of this organism. The results support the hypothesis that, in M. smegmatis, damage to DNA induces increased synthesis of enzymes associated with DNA repair.


Study on cytological effects of carofur -- a new mutagen. Chinese hamster cells (line V-79) and human leukocytes in vitro and mice of the CBA strain were treated with carofur (also called nifurprazinum), an antibacterial agent of pharmaceutical importance. At concentrations as low as 20 ppm, the in vitro treatments of cells of Chinese hamster and human lymphocytes expressed chromosome aberrations, almost exclusively of deletion type. This effect resembles that of fluorodeoxyuridine but may not necessarily reflect the same basic mechanism involved. When Chinese hamster cells were treated with 5 ppm or more of carofur for 24 hr, a 3-fold increase in the frequency of somatic sister chromatid exchanges was observed. An interesting phenomenon of "centromeric association" was observed in the bone marrow cells of mice treated with carofur, where the centromeres of the acrocentric chromosomes were oriented towards each other in groups of 2's or more.


Chromosome aberrations and dominant lethality of mouse embryos after paternal treatment with triethylenemelamine. Adult male mice were injected intraperitoneally with triethylenemelamine (TEM) at 0.3 mg/kg. These males were mated with untreated females twice a week during 24 days after the treatment. On day 3 of gestation, embryos were flushed out from uteri and examined cytologically as well as cytogenetically. A dominant-lethal test was conducted using the male treated in the same way. Paternal treatment of TEM caused developmental retardation of the embryos obtained from the matings on 20 post-injection days. These embryos frequently showed micronuclei in interphase cells and structural chromosome aberrations in methaphases. Most of these aberrations were chromosome types, such as breaks and exchanges, and premature chromosome condensations. The developmental retardation as well as the frequency of chromosome aberrations was most marked in the matings on post-injection day 13. Similarly, the highest dominant-lethal effect was shown in the group mated on post-injection days 11--13. It was concluded that TEM induces chromosome damage in the post-meiotic germ cells and then this damage in turn produces chromosome aberrations in the embryos, resulting in high incidence of dominant lethality.


Non-random distribution of cyclophosphamide-induced chromosome breaks. The mutagenic effect of Endoxan on human lymphocytes was studied both in vivo and in vitro by the QM banding technique following the usual Giemsa stain. Chromatid breaks and interchanges were observed after applications in vivo. Chromosome aberrations were not distributed at random, because of a significant increase in the number of breaks on chromosome 15. The breakpoints affected the weakly fluorescent region on the chromosomes more than the strongly fluorescent region.


Repair of radiation-induced single-strand breaks in DNA of barley embryo. Repair of single-strand breaks induced by gamma-irradiation was studied in barley embryos. Nuclei were isolated from embryos at specified times after initiation of water absorption under different temperature conditions. From the shift of the peak of DNA in alkaline sucrose gradient, it was observed that clear repair of induced breaks occurred in the irradiated embryo during 2 h after soaking. However, this type of repair was not observed after 5 h up to 16 h, because natural degradation of DNA also occurred in the non-irradiated embryos. The estimated mol. wt. of DNA from the non-irradiated dry embryo was 0.93 X 10(-8) daltons; on the other hand, it was decreased to 0.15 X 10(-8) daltons by 30 kR of gamma-irradiation. This decreased mol. wt. recovered to 0.52 X 10(-8) daltons (64% recovery) after 2 h soaking at 25 degrees C. The repair observed in this experiment was not dependent on the regular synthesis of macromolecules, especially DNA.


The effect of exposure rate on translocation induction in somatic and germ cells of the mouse (Mus musculus). The effect of exposure rate on translocation induction in spermatogonia, scored as multivalents in descending spermatocytes and bone-marrow cells of the mouse (Mus musculus) was investigated 65--100 days after X-ray and gamma-ray exposures of 400 R. In the range of exposure rates studied there was a decreased in frequency in bone-marrow cells from 17.1% at 130 R/min to 4.6% at 0.0287 R/min. In spermatogonia the frequency dropped from 6.7% at 130 R/min to 1.9% at 0.0287 R/min. The data obtained for both tissues fitted a straight line when plotted against the logarithm of the exposure rate. The ratios between aberration frequencies in bone-marrow cells and spermatogonia, with a mean value of 2.74, were independent of exposure rate.


Influenza A infections in young children. Primary natural infection and protective efficacy of live-vaccine-induced or naturally acquired immunity. To assess the impact of an influenza A/Port Chalmers infection on normal young children, we monitored 147 children during an epidemic; 121 were seronegative. There was a high attack rate (61 of 147), and a high rate of symptomatic disease (38 of 147), which resulted in frequent physician visits (25 of 38). Influenza accounted for 76 per cent of the sick-child visits during the two-month epidemic period. Young children undergoing primary influenza infection produced hemagglutination inhibition and antineuraminidase antibodies. Because of the immunologic responsiveness of young children, we examined the serologic correlates of protection. Ten children previously infected with influenza A/London and 16 who received live, attenuated A/Hong Kong ts-1[E] vaccine were protected against infection with the non-homologous A/Port Chalmers strain. The morbidity of influenza and ability of the young child to produce protective antibody should encourage evaluation of life, attenuated influenza vaccines in this age group.


Real-time radionuclide cineangiography in the noninvasive evaluation of global and regional left ventricular function at rest and during exercise in patients with coronary-artery disease. Although coronary angiography defines regions of potential ischemia in patients with coronary-artery disease, accurate assessment of the presence and functional importance of ischemia requires appraisal of regional and global left ventricular function during stress. To perform such assessment, we developed a noninvasive real-time radionuclide cineangiographic procedure permitting continuous monitoring and analysis of left ventricular function during exercise. In 11 patients with coronary disease who had normal regional and global ventricular function at rest, new regions of dysfunction developed during exercise (P less than 0.001), and in 10, global ejection fraction dropped 7 to 47 per cent. Fourteen age-matched normal subjects were studied; during exercise none had regional dysfunction, and each increased global ejection fraction (average increase, 23 +/- 3 per cent [+/-S.E.], P less than 0.001 as compared with patients with coronary disease). Radionuclide cineangiography during exercise permits accurate assessment of the presence and functional severity of ischemic heart disease.


Sjögren's syndrome association with HLA-Dw3. Sjögren's syndrome is associated with a serologically defined histocompatibility antigen of the HLA-B locus, HLA-B8. Another closely linked locus, HLA-D, determines lymphocyte-defined cell-surface antigens. In laboratory animals such antigens are closely linked to immune response genes. To determine whether Sjögren's syndrome is primarily associated with an HLA-D antigent or with HLA-A and HLA-B antigens as well as HLA-Dw3, which is known to be in linkage disequilibrium with HLA-B8. We found the primary association of association of Sjögren's syndrome to be with HLA-Dw3, which we observed in 84 percent of patients with Sjögren's syndrome in the absence of rheumatoid arthritis as compared to 24 percent in controls (P less than 0.00001). The frequency of HLA-B8 and HLA-Dw3 in patients with both Sjögren's syndrome and rheumatoid arthritis did not differ from that in controls. Patients with Sjögren's syndrome and rheumatoid arthritis comprise genetically distinct groups.


Favorable effects of hyaluronidase on electrocardiographic evidence of necrosis in patients with acute myocardial infarction. To evaluate hyaluronidase's effect in reducing post-infarction myocardial necrosis, we randomized 91 patients with anterior infarction to control (45) or to hyaluronidase-treatment (46) groups. A 35-lead precordial electrocardiogram was recorded on admission and seven days later. Hyaluronidase was administered intravenously after the first electrocardiogram and every six hours for 48 hours. QRS-complex changes were analyzed to assess the drug's effect. Precordial sites with ST-segment elevation (larger than or equal to 0.15 mV) on the initial electrocardiogram that retained an R wave were considered vulnerable for the development of electrocardiographic signs of necrosis. The sum of R-wave voltages of vulnerable sites fell more in the control group than in the hyaluronidase group (70.9 +/- 3.6 per cent [+/- 1 S.E.M.] vs 54.2 +/- 5.0 per cent P less than 0.01). Q waves appeared in 59.3 +/- 4.9 per cent of the vulnerable sites in control versus 46.4 +/- 4.9 per cent in hyaluronidase-treated patients (P less than 0.05). Thus, hyaluronidase reduced the frequency of electrocardiographic signs of myocardial necrosis.


Psychiatry and society: a sociobiologic synthesis. The very legitimacy of psychiatry as a medical speciality has been challenged by social-labelling theory: the hypothesis that psychiatric disorders are artifacts that result from assigning diagnostic labels to minor deviations in behavior and thus generating expectations that condemn the person to a career of patienthood. Close examination of the evidence demonstrats that, through improper care care retard recovery, psychiatric illness exists before the name assigned to it, and independently of theories about its genesis. In this respect, psychiatric illness does not differ from other medical problems. All human diseases reflect the outcome of an interaction between biology and social organization, with culture in a mediating role. Whatever the proximate cause of disease -- viral, genetic, metabolic or neoplastic -- the way in which society is organized affects prevalence, cause and outcome. The physician's task is to intervene to minimize distress and preserve adaptive capacity, when cure is not possible.


Hepatitis B outbreak traced to an oral surgeon. Over a four-year period in a five-county area, 71 patients with clinical hepatitis B had dental work performed in the two to six months before their illness. Fifty-five cases were traced to a single oral surgeon. Seventy-nine per cent of these patients were positive for hepatitis B surface antigen (HBsAg) and most had no other recognized source of hepatitis. An investigation of the implicated dentist uncovered no gross inadequacies in instrument sterilization or general dental procedures; however, the dentist was found to be an asymptomatic carrier of HBsAg of the same subtype (ay) as nine of 11 of his patients who had hepatitis and whose serums were available for testing. Since no HBSAg was found in the dentist's saliva, urine or feces, and since he admitted to having frequent cuts on his fingers, it is possible that a "hemoral" transmission of HBs Ag produced hepatitis in his patients.


A co-operative study for the detection of the carrier state of classic hemophilia. To determine the specificity and sensitivity of current technics for detecting carriers of classic hemophilia, three investigators simultaneously tested obligate carriers and noncarriers for immunologic and procoagulant factor VIII activity. Overall correct classification ranged from 72 per cent (36 of 50) to 94 per cent (47 of 50). The maximum accuracy obtained with the same linear-discriminant-function method on all data was 90 per cent (26 of 29) in detecting carriers without misclassifying normal persons as carriers (none of 21). Lowest accuracy by the same technic was 66 per cent (19 of 29) carrier detection while misclassifying 19 per cent (four of 21) normal persons. Precision of testing for both factor VII activity and antigen was high (standard deviations from 0.004 to 0.026 on a log scale). Differences between participants seemed related to laboratory technics rather than to statistical methods. The factor VIII activity/antigen measurement is a valid technic for detecting in the carrier state of hemophilia A.


Visual lung-sound characterization by time-expanded wave-form analysis. To characterize lung sounds objectively, we examined, by means of time-amplitude plots, selected tape recordings of auscultatory phenomena considered by six observers to be typical of those in a standard classification. Normal lung sounds could not consistently be visually distinguished from adventitious sounds at conventional chart recorder speeds of 100 mm per second or less, but the differentiation was easily achieved when the time scale of the plots was raised to 800 mm per second. When discontinuous sounds (rales, crackles or crepitations) were heard clinically, the time-expanded wave forms showed intermittent "discontinuous" deflections usually less than 10 msec in duration. When continuous sounds (rhonchi or wheezes) were heard, the deflections were usually more than 250 msec. Time-expanded wave form analysis provides reproducible visual displays that allow documentation of the differentiating features of lung sounds and enhances the diagnostic utility of the sounds.


[Exploration of humoral immunity in aspergillosis: value of enzyme linked immuno-electro-diffusion assay]. In order to increase the sensitivity of the method of immunoelectrodiffusion (I.E.D.) and to isolate the class of immunoglobulins implicated or involved in the Aspergillose antigen-antibody reaction, we supplemented the I.E.D. by combining or incorporating it with an enzymatic technique. By this method the immune complexes precipitated are taken up by antibodies conjugated to one enzyme and specific to the immunoglobulins of each class. This constitutes the technique of E.L.I.E.D.A. (enzyme-linked-immuno-electro-diffusion assay). The sensitivity and the specificity of the proposed method would allow us to follow the qualitative evolution of the aspergillar antibodies and would lend support to further arguments on the evolutionary character of the inflammatory response.


Case report: miliary blastomycosis with cerebral involvement. A patient was diagnosed as having labyrinthitis and an intracranial brain tumor. At the time a very fine nodularity to the bronchopulmonary markings was noted on the chest roentgenogram. Subsequent follow up examination revealed diffuse nodular densities throughout both lung fields having the appearance of a miliary distribution. Antituberculous therapy was begun empirically, but the patient expired within three weeks. At autopsy multiple granulomas were found in the cerebrum, cerebellum and meninges. By culture and histologic examination, these were determined to contain Blastomyces dermatitidis. The lungs contained numerous small granulomata almost to the exclusion of native pulmonary architecture. Lesions were also seen in spleen, lymph nodes and pancreas.


Investigation on dimorphism of Blastomyces dermatitidis by agar-implantation method. By the agar-implantation developed by the authors the process of conversion on Blastomyces dermatitidis from mycelial phase to yeast phase was observed. First of all slide cultures of the fungus were prepared at room temperature. Upon confirmation of good hyphal growth, a cover glass was removed and a part of medium was cut out in a square of about 3 mm a side. After mice were laparotomied, each agar block cut out was implanted in the peritoneal cavity of mouse. The mice implanted with the agar blocks were killed, two each, every day for 14 days, and thereafter at intervals of a week for 2 months. Therefore, the implanted agar blocks were all recovered. They were examined directly by a light microscope with histopathological and electron microscopic examinations carried out at the same time. Within the peritoneal cavity of mouse, the intercalary and terminal chlamydospores were formed from hyphae. These subsequently swelled to become yeastlike cells and proliferated thereafter by budding.


Utilization of keratinophilic material by selected Trichophyton terrestre spaceflight phenotypes. Phenotype strains of Trichophyton terrestre Durie & Frey produced variations in hyphal growth patterns and conidial production when subjected to human hair collected from a single source. The strains were grown from wild type conidia irradiated in space with selected wavelengths of ultraviolet light.


Comparative study of the yield of T-2 toxic produced by Fusarium poae, F. sporotrichioides and F. sporotrichioides var. tricinctum strains from different sources. Eleven strains of Fusarium poae and F. sporotrichioides from the U.S.S.R. and 7 strains of these species and one of F. sporotrichioides var. tricinctum from U.S.A. and France have been compared as to their capacity to yield T-2 toxin. The presence of this toxin was confirmed by thin layer chromatography, gas liquid chromatography and mass spectroscopy. The strains which came from the U.S.S.R. and were originally involved in causing Alimentary Toxic Aleukia (ATA), produced several times more T-2 toxin than the others. We assume that the ability of the U.S.S.R. strains to produce much more T-toxin is due to the different ecological conditions under which they were first isolated. The remarkable maintenance of so high a level of toxin production over more than 30 years of culturing is worthy of note.


[Effect of the kind of storage and culinary processing on vitamin C losses in vegetables and potatoes]. Studies on the effect of the kind of storage on the vitamin C losses in vegetables and potatoes showed that the losses were smallest after storage in a refrigerator and after long-time storage in clamps (from November to April). The losses of vitamin C that occur during boiling vegetables and potatoes are smallest if the material is added to the boiling water. Potatoes boiled in their skins showed smaller losses than peeled or quartered potatoes. Potato chips (pommes frites) lost less vitamin C during frying than potato rods. Considerable losses were observed in ready-to-eat dishes kept warm at 60 degrees C for 1 hour and then warmed up to 100 degrees C. The authors conclude that excessive vitamin C losses may be avoided in vegetables and potatoes by appropriate processing.


Isolation of amylolytic system of Aspergillus oryzae on DEAE amylum. Studying isolation technique with DEAE amylum the method was found to be suitable for isolation of alpha-amylase. After determination of optimal conditions sorption curves were illustrated, from which the amount of DEAE amylum needed for 100% enzyme sorption from solutions of various activity and origin can be calculated. Preparation obtained shows high temperature stability and can be used in food industry and agriculture or after its elution in pharmacy. At the end of the paper laboratory isolation technique is described.


[Organoleptic study of a new dihydrochalcone artificial sweetener]. The compound CH-401-Na (1-[2-hydroxy-4-(3-sulphopropyloxy)phenyl]-3-[3-hydroxy-4-methoxyphenyl]-propanone-1-Na) was studied. Its sweeting power in aqueous solution is 1000 (as compared to that of a 1% sucrose solution); the values for salts formed with 10 other cations range from 750 to 1150. In contrast to the sweet taste of sucrose, that of CH-401-Na is perceived not at the tip of the tongue but at the root of the tongue and at both sides of the oral cavity. It persists for a longer period than that of sucrose. This effect depends to some extent on the cation. The addition of inorganic salts accelerates the extinction of sweet taste. In lemonades, almost 90% of sucrose may be replaced by CH-401-salts. The taste of CH-401-Na is unpleasant in foods having a bitter taste (coffee, cola) and in low-moisture products.


[Nutritive-physiological study of sunflower seed protein isolate and spun sunflower seed protein-casein fibers]. Compared with defatted sunflower seeds, in sunflower seed globulin isolates the content of lysine and sulphur containing amino acids is decreased, the content of phenylalanine is increased. The content of the whole essential amino acids of sunflower seed globulin isolate in relation to casein is decreased. The value of the enzymatic invitro available amino acids of sunflower seed globulin is comparable with casein. The digestibility is good, the biological value is in relation to defatted sunflower seed lower. Apart from the lower content of sulphur-containing amino acids the amino acid composition of spun sunflower seed globulin/casein (I:I) fibers corresponds with the calculated value; in relation to sunflower seed globulin isolate the content of lysine and the whole essential amino acids of the spun protein fibers is increased. The enzymatic in-vitro-hydrolysis results altogether in a comparable availability of the amino acids between spun protein fibers and sunflower seed globulin isolates. The digestibility and the biological value of spun protein fibers corresponds with that of casein.


[Behavior of certain parameters of lipid and energy metabolism. IV. Regulation of lipid and energy metabolism in livers and race and mini pigs]. To characterize the lipid and the energy metabolism in the livers of genetically different types of pigs (land race pig and mini pig), the authors determined the activities of enzymes typical of and limiting these metabolic pathways. Furthermore, they measured the concentrations of typical metabolites and ascertained parameters that are of importance in energy metabolism. The concentrations of acetyl CoA and free fatty acids in the livers of mini pigs were significantly greater than those in the livers of land race pigs, whereas the cholesterol, glycerol, triglyceride and acetoacetate concentrations were reduced. The activities of glucose-6-phosphate dehydrogenase (E.C.1.1.1.49.), citrate synthase (E.C.4.1.3.7.) and ATP citrate lyase (E.C.4.1.3.8.) were lower in the livers of mini pigs than in the livers of land race pigs, whereas the activity of fatty acid synthase was higher. The concentrations of cyclic 3',5'-adenosine monophosphate (AMP) and adenosine diphosphate (ADP) were lower in the livers of mini pigs than in those of land race pigs. In land race pigs, the metabolic process seems, therefore, to be determined in favour of the degradation of free fatty acids and of the generation of energy. In mini pigs, lipogenesis in the liver appears to be the decisive metabolic pathway. The possibility of a higher coordinating control mechanism of the lipid and the energy metabolism is discussed.


Direct demonstration of beta-globin mRNA in homozygous Ferrara betaO-thalassaemia patients. In cases of betaO-thalassaemia from Ferrara, Italy, the beta-globin gene in transcribed into mRNA but no protein is synthesised. For these cases there is no hybridisation data suggesting a globin gene structural mutation. This again demonstrates the diverse molecular events which may cause this prevalent hereditary disease.


Androgens in the anaemia of chronic renal failure. Plasma levels of testosterone-like substances (TLS) were depressed in seven patients with chronic renal failure. Intramuscular testosterone (as Sustanon 250 once a week) elevated plasma TLS levels to above normal throughout the week with an initial high peak. Sublingual testosterone produced a high but brief peak in TLS. Results were similar in renal failure patients and normal controls. A controlled trial of weekly Sustanon 250 in 24 regular dialysis patients produced a significant increase in haemoglobin from 6.8 to 8.2 g/dl. Side effects were mainly mild and acceptable but one patient developed priapism and another a large haematoma. The discriminate use of androgens is recommended for anaemic male patients on regular haemodialysis.


Relationship between glomerular filtration rate and tubular reabsorption of sodium in patients with unilateral renal artery stenosis. The role of the renal prostaglandins. In patients with renovascular hypertension, a significant decrease in glomerular filtration rate (GFR) and in renal plasma flow (RPF) in the stenotic kidney was accompanied by a significant homolateral decrease in extraction of PAH(EPAH) and in net tubular reabsorption of sodium (RNa). There was a highly significant correlation between differences in RNa and differences in either GFR or RPF, while no correlation between differences in RNa and in EPAH was noted. It is suggested that the nature of the relationship between GFR and RNa is essentially the same in unilateral renal artery stenosis in man, as in acute constriction of the renal artery or the aorta in the experimental animal.


Vitamin D-induced hypercalcemia in experimental renal failure. Hypercalcemia was induced in 5/6 nephrectomized rats fed a low calcium diet by administering pharmacologic doses of vitamin D. The degree of hypercalcemia was greater in uremic rats than in sham-operated rats both of which were given vitamin D. Bone resorption was marked in both groups but differed in distribution. Increased osteoclasis in uremic rats was limited to diaphyseal cortical bone while metaphyseal trabeculae were relatively unaffected compared to sham-operated rats administered vitamin D. Ultrastructurally thyroid C cells were degranulated and in an active stage in both groups of rats receiving vitamin D. Urinary calcium excretion was greater in sham-operated rats given vitamin D than in uremic rats. The greater renal retention of calcium in uremic rats given vitamin D was felt to contribute to the development of hypercalcemia. These studies suggest that although trabecular bone was resistant to pharmacologic levels of vitamin D in renal failure, hypercalcemia developed due to selective resorption of cortical bone and impairment of renal calcium excretion.


Studies on the site of renal sodium loss in two patients with cystinosis. Effects of hydrochlorothiazide on tubular sodium reabsorptive mechanisms. The purpose of this study was to examine the effect of hypotonic saline diuresis on two patients with cystinosis, trying to localize the site of renal sodium loss. At the same time, we have performed the same hypotonic saline infusion under hydrochlorothiazide administration. Results seem to prove the proximal tubular localization of the salt-wasting syndrome in cystinotic patients. On the other hand, these results suggest that hydrochlorothiazide effect can be related to the hypovolemia due to the distal tubular action of hydrochlorothiazide that could inhibit the 'third' natriuretic factor, thus increasing the proximal tubular sodium reabsorption.


High prevalence of pancreatic disease in chronic renal failure. The prevalence of pancreatic disease was determined in 21 autopsied uremic patients who had died during the course of maintenance hemodialysis, as compared with 60 autopsied patients without kidney or pancreatic disease. Histologic criteria of pancreatic disease included. (1) duct ectasia; (2) periductal fibrosis; (3) ductular proliferation; (4) acinar ductalar metaplasia, and (5) interstitial inflammation or fibrosis. Significant pancreatic disease was present in 56% of the uremic patients and only 11.8% of the controls (p less than 0.01). Two uremic patients had abscesses in the tail of the pancreas. The clinical significance of the high prevalence of pancreatic pathologic alterations in uremia remains to be assessed.


The Lundia Mini-Minor: a disposable dialyzer for hemodialysis of very small patients. We have in vitro and in vivo tested the new Gambro Lundia Mini-Minor pediatric dialyzer with the 17 micron membrane. By utilizing blood tubing sets of different volumes in conjunction with the Lundia Mini-Minor we feel that this dialyzer is well suited to use in pediatric patients weighing less than 16-23 kg. During the last 4 years, with the development of improved equipment and techniques, it has become increasingly easier to hemodialyze children and infants with end-stage and acute renal failure [1,2]. We have previously reported our experience with hemodialyzers designed especially for children and babies [1-5, 13, 14]. This report concerns our experience with a new disposable pediatric hemodialyzer, the Lundia Mini-Minor, which has been designed for the smaller pediatric patient weighing less than 16 kg.


Computed tomography in the postoperative care of neurosurgical patients. By its ability to differentiate the densities of various intracranial tissues, computed tomography is an ideal tool to investigate the postoperative course and complications of neurosurgical patients. The most important immediate postoperative complications are intracerebral edema and epidural, subdural or intracerebral hematomas. The extent of surgical resection of neoplasms can also be studied easily by CT. The method of investigation and representative cases are described.


Acute renal failure after cerebral arteriography in a diabetic patient. A case of acute renal failure after cerebral arteriography with iodinated contrast material in a patient with diabetes and azotemic nephropathy is described. A review of the literature concerning acute renal failure after radiographic contrast material is included. The main risk factors reported in the literature appear to be the presence of diabetic nephropathy and the administration of fairly large doses of iodinated contrast material. Azotemic patients should be kept well hydrated and receive doses of less than 50 cc/m2 of body surface area when studied with such materials. Careful monitoring of urinary output and serum creatinine and ready access to dialytic therapy will aid in the detection and subsequent treatment of this problem.


Pattern of radioactivity in the CSF after intravenous injection of 99mTc. It has been shown that intravenously injected pertechnetate enters to CSF space and also that a transport of pertechnetate ions to the blood occurs when injected into the ventricles. Activity curves obtained by repeated samplings of CSF after intravenous injection of pertechnetate appears to differ at different levels of the intraventricular pressure but also in patients with different types of intracranial pathology, i.e. in patients with ventricular dilatation due to hydrocephalus and due to cerebral atrophy.


Computed tomography in the diagnosis of cerebral abscess. Computed tomography (CT) was performed 64 times on 22 patients with cerebral abcesses, using the 160 X 160 matrix EMI scanner. The diagnosis was based upon the demonstration of a localized low-attenuation area appearing, after the administration of contrast medium, as a high-attenuation annular rim ascribed to displaced and/or newly formed vessels, the so-called abscess membrane. CT is compared with the conventional diagnostic methods of neuroradiology. The differential diagnostic accuracy of CT is clearly superior to that of previous methods, including angiography, which, until now, we have considered the most accurate method.


Internal carotid artery blood flow during cerebral angiography. A total of 13 contrast injections of Isopaque Cerebral (meglumine metrizoate) were made into the precerebral arteries or the aortic arch in 6 patients and the bilateral internal carotid artery blood flow monitored continuously using implanted electromagnetic blood flow probes. The most frequent causes of flow changes were found to be due to sudden changes in arterial blood pressure or ventilation which caused a simultaneous and generally identical flow pattern in the two arteries. In 4 patients a slight increase in flow in the artery receiving contrast medium was observed; the increase ranged from 10 to 20% above control level. In one patient the ICA receiving contrast medium showed an initial drop in blood flow to about 85% within 15 sec while the contralateral side showed an increase in flow to about 110%. This sequence was followed by a 6 minute period of slightly increased blood flow on the injection side while the other side showed a slight decrease. A discrepancy in carotid vasomotor response was seen after the injection of 50 ml of contrast medium into the aortic arch with filling of both carotids in the angiogram. Flow changes thought to reflect "arterial spasm" (increased vascular resistance) were observed during attempts to puncture the common carotid artery. The risks connected with this method are discussed. Repeat flow recordings throughout the 24 hours following angiography did not show flow changes attributable to the angiographic investigation.


Arteriography of the anterior communicating aneurysm. Optimal projections for the delineation of anterior communicating aneurysms were investigated by means of model experiments and the results applied to 30 clinical cases. The oblique half-axial, the oblique orbital, the full axial, and the reverse oblique projections proved useful adjuncts to conventional projections in studying the anterior communicating aneurysm.


[Changes in the angiographic pictures in Raynaud's disease following acupuncture treatment]. Angiograms obtained before and after acupuncture in a small series of patients with Raynaud's disease did not give positive evidence of its therapeutic effect. A marked vasodilatatory action was noted, however, suggesting that the technique can be usefully applied along with other forms of management.


[Surgical analgesia by acupuncture. Studies of more than 500 cases]. This report was read to the National Congress of the Italian Anaesthesia Society in 1976. A personal series of acupuncture induced anaesthesia is presented and a number of general remarks are made regarding the application of the technique to various areas of surgery.


[Acupuncture and psychiatry. Preliminary note]. Personal experience with acupuncture as a therapeutic technique in psychiatry is presented. Its effects on the patient and the taking of drugs are discussed. The results, like those reported by Chinese and other Italian workers, were encouraging and indicate that the technique may be more widely adopted in this field.


[Treatment of subacute and chronic rhinosinusitis]. Four personal clinical cases of paranasal sinus pathology are reported. The therapeutic technique and clinical course of this commonly observed otorhinolaryngological and general medicine condition are illustrated and a personal contribution made to its resolution.


[Complications of acupuncture: viral hepatitis]. Complications arising in association with acupuncture are frequently reported. Some are strictly technical, others--including viral hepatitis--are the result of hygienic problems. A statistical assessment of the frequency of HB antigen in out-patients treated during 1975 is reported.


[Principles in the treatment of arthrosis of the cervical vertebrae]. Electromyographic variations by means of acupuncture. Electromyography is carried out in the treatment of severe arthrosis of the spinal column where radiology has shown a narrowing of the intervertebral spaces. Electromyography is also useful for determining the variations shown by the nerve during acupuncture.


[Antihypertensive effect of indapamide]. 2.5 mg/day indapamide was administered to 16 hypertensive patients for 30 days. These was a gradual, significant reduction in systolic and diastolic pressure values with no significant changes in plasma and urinary electrolytes. The effect of the drug on ARP and renal performance was also examined. There were no alterations of other metabolic parameters. These data point to a safe and lasting hpotensive action on the part of indapamide.


[Post-traumatic pulmonary hematoma].

[Post-traumatic pulmonary hematoma]. Pulmonary haematoma is relatively rare. Though on the increase as a consequence of a rise in the number of road accidents, it is not necessarily traumatic in origin. Three cases (two post-traumatic, out of 250 serious chest trauma cases examined) observed at the University of Turin chest and lung surgery centre over the last three years are presented. Data from the literature are also cited. A description is given of the typical radiological features: roundish opacity with distinct edges, homogeneous, in the site the pulmonary or subpleural ligament, slow involution. This picture may be sufficient for diagnosis when the history is not clear.


[Australia antigen and viral hepatitis. Clinico-statistical considerations]. 204 cases of viral hepatitis, 192 related to the MS1 form and 12 to MS2, were studied for the presence of Au. antigen and possible relations between this and the course of the disease. The antigen was encountered in 12 cases of the first group (6.2%) and in 7 of the second (58.3%). The disease was more serious and developed more slowly in Au.-positive cases compared to negative cases, it was also observed that only after the disappearance of the antigen from the serum was clinical cure possible.


[Renal control of acid-base equilibrium during dyslipidemia]. Possible correlations between lipid metabolism and hydroelectrolytic and acid base balances were studied in pathological conditions. For this purpose 24 patients with essential dyslipidaemia without renal or hepatic disease, and 47 patients with varying disease conditions, 25 with profound alterations in the lipid balance, 22 with plasmatic lipid fractions completely normal, were studied. In cases of essential hyperlipidaemia, alongside the profound changes in the lipid complement, no significant alterations in plasma pH were observed; by contrast other cases frequently showed an upset acid base balance with or without changes in the lipid picture. Urinary determinations suggested different conclusions. The most important aspect was the observation in most cases of essential dyslipidaemia and in certain cases of secondary dyslipaemia, of paradoxical aciduria, namely aciduria of much greater extent than might have been expected on the basis of plasma pH value.


[Relations between hypotensive effect and modifications of volemia and plasma renin activity in patients with essential hypertension treated using spironolactone]. The hypotensive effect of spironolactone and its relation to the changer in volaemia and renin activity induced by the drug were studied in 12 hospitalised patients with essential hypertension. After 4 weeks, arterial pressure was significantly decreased in direct relation to reductions in plasma volume in 9 subjects in both the erect and the recumbent position. These reductions were probably responsible for an increase in renin activity noted (sometimes at significant levels) in all subjects. It would appear that such increase does not impede the hypotensive effect of the drug. The hypotensive response was, in fact, less marked in only 3 patients, whose basal renin levels were themselves high.


[Clinical and functional aspects of obstructive respiratory syndromes following administration of a single dose of salbutamol in aerosol form]. 30 subjects suffering from obstructive type chronic bronchopneumopathies were treated with salbutamol, a new Beta2 stimulating bronchodilator, administered by aerosol in a single dose of 200 gamma. Clinically the bronchospasm resolved itself or was reduced in just a few minutes in more than 70% of cases. Functionally, the various spirometric parameters were followed up for six hours and showed that the drug is capable of reducing flow resistance in rapid, lasting fashion, thus improving airway conductivity and making lung ventilation more homogeneous. No cardiovascular alterations were encountered.


[Site of 1st appearance of pain in primary arthrosis. Clinico-statistical studies in a thermal bath environment]. An investigation of the first site of joint pain in 3,419 subjects with primary arthrosis is reported. In both sexes, the lumbar region was by far the most common, followed by the neck, the knee, and other joints; marked and significant differences between males and females were noted. While the data do not clearly show that the first pain site and the first site of involvement are the same, it is felt that this is a fairly constant occurrence. Since bearing joints are concerned in the lumbar region and a psychosomatic site in that of the neck--this, in fact, is twice as frequent in women as in men, this constancy serves to bring into discussion the primary and secondary nature of arthrosis, at least in a certain number of cases.


[Pre- and postoperative treatment of pulmonary suppuration]. A group of patients presenting a pathology of pulmonary suppuration is examined and a type of basic treatment used for preparing such patients for surgery, not always indicated by suppuration, is presented. A number of clinical and functional parameters measured before and after such treatment are also examined. The therapy carried out personally in the immediate postoperative period and in the long term is illustrated.


[Desferrioxamine in the diagnosis of hypo-, normo-, and hypersiderotic hyposideremia]. Evaluation of stored iron by means of DFOX-induced sideruria in 101 subjects with various degree of hyposideraemia with or without anaemia, is reported. Three groups were examined: 49 patients with chronic loss of blood and malabsorption and urinary iron values up to 1 mg/24hr; 43 with non-bleeding neoplasia, collagen disease, lymphoma, cirrhosis of the liver etc. and values of 1-2mg/24 hr; 9 with rheumatoid arthritis and cirrhosis of the liver and values over 2 mg/24 hr. The reasons why hyposideraemia may accompany incipient of frank tissue hypo-, normo- or hypersiderosis are discussed.


[Experimental research on the artificially induced antibody immunity in the healthy man and in the patient with liver cirrhosis]. The ability to produce antibodies against strong (S. typhosa and S. paratyphi) and weak (tetanus toxide) antigens and the consequent changes in serum IgG's, IgA's, and IgM's were compared in patients with cirrhosis of the liver and healthy controls. A significantly higher response, especially to strong antigens, was noted in the cirrhotics, while their bone marrow contained an appreciably greater number of lymphocytes and plasma cells. Increased Ig production in cirrhosis is seen as the expression of general over-production of antibodies and hence devoid of any specific relation to its immune pathogenesis. The conclusion is drawn that the liver may be in some way responsible for the regulation of antibody synthesis and that this capability is "disinhibted" in cirrhosis.


[A case of primary hyperparathyroidism sustained by parathyroid adenocarcinomatosis]. Primary hyperparathyroidism may at times be associated with carcinoma of the parathyroids. A personal case of primary hyperparathyroidism was operated on by total thyro-parathyroidectomy. The histological picture presented atypical cell patterns and infiltrations of the thyroid capsule, together with adenomatuous parathyroid formations suggesting the possibility of a malignant transformation of initially benign process. Given the benign clinical course, it is possible that when subjected to radical, timely measures, even atypical parathyroid processes may be cured completely.


[Solitary granuloma in ocular Toxocara-canis infection (Canine round worm)]. Two cases of Toxocara canis infection are reported. They presented a solitary granuloma at the posterior ocular pole. The eyes affected by parasites were practically blind. In the first case the condition was discovered accidentally on a pre-employment examination; in the second case, after a change of doctor - the previous diagnosis was toxoplasmosis. The latter mistake is very common in Toxocara infections. Our diagnoses were confirmed by Lamina's microprecipitation test. For treatment the Anthelminthinc 'Minzolum', or photocoagulation with steroid treatment can be used.


Larva migrans lentis.

Larva migrans lentis. A unique case of a larva migrans lentis in a 33-year-old female is presented. The intraocular larval (obviously Toxocara) affection was characterized in the first phase by the development of a peripheral chorioretinal granuloma and in the second phase by the finding of larva migrans in the lens. The lively larva appeared several times in the pupillary area under the anterior and posterior lens capsule and survived an intensive treatment by Mintezol.


The Riley-Day syndrome. Familial dysautonomy, central autonomic dysfunction. The Riley-Day syndrome is characterized by a dysfunction of the autonomous nervous system, sensory disturbances, neurological disorders, psychical anomalies and important ophthalmological symptoms, such as absence of tears, corneal anaesthesia, keratinized conjunctiva and cornea; myosis after instillation of methacholine. The diagnosis is based on the absence of fungiform papillae of the tongue and the absence of reaction after intradermic injection of histamine. The inheritance is autosomal recessive. The disease results probably from an enzymatic insufficiency.


Histologic and electromyographic research on a case of recurrent alternating extrinsic paralysis. Possibility of former myopathic origin. Electromyographic and histologic tests made on a case of recurrent alternating extrinsic paralysis would point toward a previous myopathic origin of the disorder.


The development of intramedullary cavitation following spinal cord injury: an experimental pathological study. It is concluded from this investigation that localised intramedullary cavitation will develop following non-disruptive spinal cord trauma if the magnitude of original trauma and resulting vascular damage is sufficient. Although an adhesive arachnoiditis also occurs with similar amounts of trauma, the initial vascular damage and subsequent reparative changes within the spinal cord appear to adequately explain the cavitation observed.


Acute central cervical spinal cord syndrome--aetiology, age incidence and relationship to the orthopaedic injury. A series of 99 cases of acute central cervical spinal cord syndrome is reviewed. This represents 25% of all acute cervical spinal cord injuries (excluding stabs and gunshots), admitted to the Spinal Cord Injury Centre, Conradie Hospital during an 8-year period (November 1963 to December 1971). Aetiology, age incidence and relationship to injury is discussed.


Results of rehabilitation in central cord syndromes. Out of 180 cervical cord syndromes (traumatic, neoplastic and vascular) studied we examined the prognosis of rehabilitation in 31 central cord syndromes dating back from 6 months at the least or 6 years at the most.


Survival in traumatic transverse myelitis. Spinal cord injury resulting in paraplegia or tetraplegia has from time immemorial led to early death. Mortality figures as high as 80% over a few years have been noted. Following World War II as a consequence of the intensive care extended to these casualties, the mortality has been significantly diminished. The mortality has been studied on three occasions by the authors and two previous papers have been published, the first in 1961 and the second in 1968. The present paper is based on a mortality and longevity study which covers the period from 1 January 1945 to 30 November 1973, an interval of 29 years less one month. It deals with the mortality of spinal cord injured persons following treatment in Lyndhurst Lodge Hospital and reveals that there has been significant improvement over the period of study.


Electrodiagnosis in post-traumatic syringomyelia. Development of a syrinx several years post spinal cord trauma is a well-known entity and described in a number of scientific communications. Each one describes the few cases encountered with the clinical presentations; many report results of myelography with positive or negative contrast media, operative procedures, and eventual outcome as well as discussions of autopsy material. It is believed by many investigators and clinicians that surgical intervention frequently stops the progression of the syrinx and sometimes even reverses the symptomatology. Early exact diagnosis is thus paramount. Electromyography if used judiciously, may be an important adjunct to proper diagnosis and prognosis. In a patient with previous spinal cord trauma, frequently even post-surgical procedures, the interpretation is often difficult. This paper discusses the electrodiagnostic findings in three patients with post-traumatic syrinx and compares them with electrodiagnostic changes observed in a spinal cord injury patient with increased symptomatology due to other causes and two patients with non-traumatic cervical syringomyelia.


Cervical spinal cord injury without bony injury. Cervical spinal cord injury without demonstrable bony injury occurred in 141 (37%) of 384 successive neck injuries admitted to the Sheffield Spinal Injuries Unit. The condition was common in patients in the older age-groups and there were 70% of the cases who were over the age of 50 years. The commonest cause was a fall. The patients presented with varying degrees of motor paralysis with the greatest deficits in the upper limbs and lesser deficits in the lower limbs. There was a dissociation of impairment of the sensory modalities and a loss of bladder and bowel control.