Morbidity/mortality and economics of hospital-acquired blood stream infections: a controlled study. A controlled study of mortality, length of hospital stay, and cost of hospitalization in 40 patients with hospital-acquired blood stream infections and 40 similarly ill patients without blood stream infections was done. Patients with septicemia were identified by ongoing routine surveillance, while controls were selected from computer surveys of similarly aged patients matched for primary diagnosis of operation or both. Bacteremic cases for which no matched controls could be obtained and 109 additional cases of blood stream infection occurring after the study period were also characterized to determine any gross bias in the process of case selection. Mortality in bacteremic patients was 38% compared to 10% in controls; median hospital stay was 33 days for bacteremic patients and cost was $6,692, compared to 14 days' hospitalization and $2,322 cost for controls. Mortality among the unmatched cases as well as the 109 additional cases was 34%. The excess morbidity, mortality, and hospitalization costs offer a better estimate of the direct effects of the hospital-acquired blood stream infection.


Role of antibody-coated bacteria in the management of urinary tract infections. The antibody-coated bacteria (ACB) test was used to localize the site of urinary tract infection in a group of pediatric and adult patients. Duration of treatment of ACB-positive (upper tract) and ACB-negative (lower tract) infections was correlated with rates of recurrence during follow-up for six or more months. Two relapses with the same organism occurred after 29 ACB-negative episodes were treated with a short course of antimicrobials (less than or equal to 14 days). Of patients with ACB-positive infections, all four given similar short-duration therapy experienced relapse with the same organism, but none of nine had relapse after long-duration therapy (greater than or equal to 28 days). High cure rates were obtained with less than or equal to 14 days therapy in ACB-negative infections and with greater than or equal to 28 days therapy in ACB-positive cases. The ACB test promises to be useful in predicting the appropriate duration of antibiotic therapy.


Salvage cystectomy after radiation failure in patients with bladder carcinoma. Thirty-two patients with cancer of the bladder definitively treated with irradiation had radical cystectomy without lymphadenectomy for treatment of recurrent or persistent tumor. Preoperative clinical staging was accurate in distinguishing between superficial and deeply invasive disease in 94% of patients, while in 44% and pathologic stage were identical. There were no postoperative deaths. Fourteen patients have no evidence of disease 11 to 75 months post-operatively, 14 developed recurrent disease two to 20 months after surgery, and four died of other causes after satisfactory recovery from surgery. Assessment of clinical stage offers the best prognostic indication of survival, as all patients whose tumor was 15 (carcinoma in situ) or T1 survived without developing recurrent whereas only six patients with stage T3 or greater are alive without recurrent disease. Cystectomy can thus be recommended for selected patients with bladder cancer who have failed definitive irradiation therapy.


The thoracic outlet syndrome as a cause of aneurysm formation, thrombosis, and embolization. The thoracic outlet syndrome may have a serious vascular component consisting of subclavian artery aneurysm with possible thrombosis and embolization which can result in severe ischemic symptoms in the upper extremity, gangrene, amputation, and even hemiplegia. Four cases of subclavian artery aneurysm in association with thoracic outlet syndrome are presented. Two of the patients required surgical intervention because of thrombosis and embolization, while the other two had prophylactic surgical procedure to prevent those complications.


Vascular changes in leg trauma.

Vascular changes in leg trauma. Fifteen patients with closed fractures of the distal tibia and fibula had marked elevation of initial compartment pressures. The pressures remained elevated for five days in the ten patients treated by cast and elevation. The pressures returned to normal within 24 hours in the five patients placed in a prototype water-jacketed boot which provides cooling and intermittent compression. Some patients exhibited arteriographic evidence of vascular injury.


Aspiration and irrigation of congenital and traumatic cataracts. Aspiration and irrigation of congenital and traumatic cataracts has proven to be a successful procedure over many years. The purpose of this paper is to reemphasize the importance of this procedure and, more particularly to point out the comparative advantages of two-needle aspiration and irrigation to phacoemulsification, roto-extraction, double-bore cannula, and intracapsular extraction. A new, inexpensive handle for aspiration and irrigation is discussed. This handle eliminates the need for an assistant while performing the procedure.


Disarticulation for failed surgical procedures about the hip. Complications following treatment of disease about the hip may render a limb so nonfunctional that the patient is confined to bed or a wheelchair. Admitting therapeutic defeat and knowing "how and when to quit" may be wise. Four chronically disabled patients released from their confinement and rehabilitated by disarticulation of the hip are described.


Coxa magna.

Coxa magna. Coxa magna is probably due to a period of relative hyperemia of the capial femur epiphysis between 2 and 8 years of age. The peripheral cartilage of the metaphysis and epiphysis proliferate as a response to reactive hyperemia secondary to synovitis. We have observed 11 patients with coxa magna and have followed five in detail. Good function is expected in childhood and adolescence, but traumatic arthritis will probably occur as these patients get older.


Extra-anatomic bypass grafting in aortoiliac occlusive disease: a seven-year experience. In recent years, axillofemoral and femorofemoral bypass grafting have emerged as alternate methods of managing severely ill patients with aortoiliac occlusive disease. Additionally, axillofemoral grafting is indicated when intra-abdominal graft infection necessitates closure of the aorta. Femorofemoral bypass grafting has been advocated in similar high-risk patients who have unilateral occlusive disease. The inherent safety of both of these procedures and their success in relieving occlusive symptoms have been reported by several centers. Our success with axillofemoral grafting has led to the continued use of this procedure in appropriate clinical situations. The success and safety of femorofemoral bypass grafting has led us to advocate its use in most patients with unilateral occlusive disease, and we often find it the procedure of choice for treating symptoms related to occlusion of one limb of an aortic bifurcation graft.


Evaluation of postexcisional strontium 90 beta ray therapy for pterygium. During a ten-year period, 211 patients with a diagnosis of pterygium were treated in the University of Texas Medical Branch by a combined effort using a strontium 90 beta ray applicator immediately after surgical excision. Only one patient developed recurrence. No complications were observed during the first year of follow-up.


Dysphoria and impaired mentation in young physicians. A syndrome of dysphoria and impaired mentation afflicting young physicians is described. Complaints involve a perceived inability to remember recently read medical literature and a perceived lack of ability and "memory lapses" in the clinical care of patients. This syndrome occurs at a time when the young physicians' professional role is in transition and when he has just assumed increased clinical responsibilities. Resolution of the syndrome may be facilitated by a suggested protocol.


Postoperative deaths due to unsuspected pheochromocytoma. Two cases of postoperative death due to unsuspected pheochromocytoma are presented. Both patients exhibited signs and symptoms preoperatively which might have been attributable to a pheochromocytoma. These reports serve as a reminder of the potentially fatal consequences of inadequate evaluation of hypertensive patients before surgery.


Fatal amniotic fluid embolism during induced abortion, 1972-1975. From 1972 to 1975, four women have died in the United States from documented amniotic fluid embolism during legal induced abortion. These women, whose pregnancies ranged from 14 to 35 menstrual weeks, had intra-amniotic saline instillation (three cases) and hystereotomy (one case).  Performance of abortion in the first trimester and use of curettage technics could minimize the risks of this catastrophe.


Fatal intrahepatic hemorrhage after percutaneous liver biopsy using a Menghini needle: a rare but real complication. Serious intrahepatic hemorrhage with hemoperitoneum after percutaneous liver biopsy is a rare but potentially fatal complication. This paper describes a fatality following liver biopsy with a Menghini needle, the first to our knowledge occurring without pre-existing liver disease. The bleeding was thought to result from laceration of dilated vessels near the periphery of the liver, a condition which cannot be predicted by any means presently available. One should be cognizant of the fact that although percutaneous liver biopsy is an extremely safe procedure in competent hands, it nevertheless carries a very definite risk and should neither be used injudiciously nor taken lightly. This case should serve as a reminder of this fact.


Pyogenic granuloma of the oral cavity.

Pyogenic granuloma of the oral cavity. A case of pyogenic granuloma on the tongue of a woman who was seven months pregnant is reported. A brief review of the literature is given along with suggestions for the management of similar cases.


Topical corticosteroid therapy complicating congenital glaucoma. A 4-month-old infant with congenital glaucoma had been treated with a topical antibiotic-corticosteroid for three months. This fact complicated initial management, delaying definitive diagnosis and therapy. Topical steroid therapy in infants can produce a condition simulating congenital glaucoma. Since there is little rationale for using topical steroids to treat most infantile external disease processes, they are best avoided. When steroids are used for a prolonged period, some strategy for detecting glaucoma should be adopted.


Methoxyflurane hepatitis.

Methoxyflurane hepatitis. A veterinarian's assistant who sniffed methoxyflurane as a euphoriant developed fulminant hepatitis and died of hepatic failure. The abuse of fluorinated anesthetics has been reported and may be more frequent than is commonly believed. It is suggested that fluorinated anesthetics should be considered as a causative agent in a case of fulminant hepatitis, especially in patients who have easy access to such drugs.


Hemochromatosis associated with side-to-side portacaval shunt. A patient is described who developed the full-blown picture of hemochromatosis 24 months after a side-to-side portacaval shunt. No clear-cut explanation for this rapid development of hemochromatosis is apparent and a possible mechanism for this phenomenon is discussed.


Hypothyroidism and hypercalcemia: report of a case with a parathyroid adenoma and review of the literature. A woman with hyperthyroidism, hypercalcemia, and a parathyroid adenoma is described. Various studies indicate that in hypothyroid subjects given an acute dose of calcium, the serum calcium levels remain elevated for longer periods than in control subjects. In part, this may be due to diminished bone uptake. Despite these studies which would tend to support the contention that hypothyroid patients "have a propensity to hypercalcemia" (Lowe et al), overt and significant hypercalcemia is unusual. Hypothyroidism is listed as a possible cause of hypercalcemia. This does not seem to be warranted by a review of the literature. The reference most often cited is that of Lowe et al. In their particular case, the hypercalcemia improved with thyroid replacement therapy. This also happened in our case. However, the measurement of IPTH levels led to the correct diagnosis. IPTH levels were not available at the time of Lowe's report and hyperparathyroidism was not completely excluded. Therefore, at this time, the reported association of hypercalcemia with adult hypothyroidism needs further examination to determine if this association is real.


Anesthetic management of patients with epidermolysis bullosa. Presented is a 12-year-old girl with epidermolysis bullosa who required anesthesia for extensive dental rehabilitation. Patients with epidermolysis bullosa can be given anesthetics with minimal complications if the preoperative evaluation is complete, the selection of anesthesia is appropriate, and certain procedures which cannot be safely used in patients with this disease are conscientiously avoided.


Brugia timori: experimental infection in some laboratory animals. Experimental infection with Brugia timori of 7 jirds (Merionesunguiculatus), 4 cats and 2 monkeys (Macaca fascicularis) is described. Although no microfilariae were detected by examining 20 microliter samples of tail blood of jirds, adult worms were recovered from 6 of the 7 jirds at autopsy 69-141 days following infection. Some worms were gravid and microfilariae were found in visceral blood of 2 animals. The adult recovery rate in jirds was 16%; the male to female ratio was 1:3. In cats patent infection developed in 95-105 days but microfilaraemias were of low level and transient. No parasites were recovered from monkeys.


The periodicity of Brugia malayi in South Thailand. The periodicity of Brugia malayi microfilariae were studied in the two endemic areas of the South Thailand i.e. in Pattani and Narathiwat provinces. It was found that in Pattani province the microfilariae had a markedly nocturnal periodicity character while in Narathiwat province they were of a nocturnal sub-periodic type. Moreover, the microfilariae of periodic form in Giemsa stained blood films usually had "unsheathed" appearance (71.5%), while those of sub-periodic type were mostly of "sheathed" form (93.4%).


Experimental cross-breeding of Ancylostoma tubaeforme (Zeder, 1800) and Ancylostoma caninum (Ercolani, 1859). In experimental crosses between A. tubaeform and A caninum the worms failed to produce progeny in dual-strain combinations. Even though these two strains did not fail to copulate. Egg production was observed only in identical single-strain combinations. This supports the assumption that the two species are genetically separate and valid.


The persistence of naturally formed mit (Acarina: trombiculidae) foci in Malaysia. Mite foci were fenced above and below ground to prevent the entry of host animals and to prevent the migration of mites within the soil. Weekly counts were made over a period of thirty weeks with larvae being collected at the beginning and end of the study, but not during the intervening period of hot, dry weather. Post-larval forms can survive for long periods and mite foci can remain productive without being visited by the host animals. Mite foci may be missed by normal survey methods during hot, dry weather.


The effects of rainfall on trombiculid (Acarina:trombiculidae) larval populations in peninsular Malaysia. Studies of larval mite populations along transects, as measured with black plates, were conducted in forest and grassland habitats for a period of 67 weeks. Larvae of both Leptotrombidium (Leptotrombidium) deliense and L. (L.) fletcheri were influenced greatly by rainfall, with the larvae being abundant and easily collected during periods of heavy rainfall and difficult or impossible to collect during dry periods. Simulated rainfall maintained larval populations for longer periods during dry weather.


Nidal delineation of Thailand: an approach to disease ecology in major nidal base regions. Provisional nidal base regions have veen delineated for Thailand. The nidal base regions so derived were compared by computing the percentages of species common to pairs of provinces (coefficient of community, CC). The results provided a CC matrix and dendrogram showing the relationship between regions, combined with the general geographic and climatologic conditions. Six ecological regions have been designated, of which five are classified as super provinces (Northeast, Central, East, South and Far South), while only one is a subregion (North). Problems of error in the data are discussed and the need for further accurate analysis to further the goal of control of disease.


Antistreptolysin O titers of cats infected with Brugia malayi and with streptococci. This study evaluated the usefulness of determining antistreptolysin O(ASO) titers in filariasis. The ASO titers were elevated in most convalescence sera, but did not reflect comparable pathology resulting from dual Brugia-streptococcal infections in cats.


Prevalence of intestinal helminths among patients admitted to the Balik Pulau district hospital on Penang island. Faecal samples from patients admitted to the District Hospital in Balik, Pulau, Penang revealed high infection rates for Ascaris lumbricoides, Trichuris trichiura and hookworms. The prevalence rates were Trichuris trichiura 51.7%, Ascaris lumbricoides 31.9% and hookworm 37.2%. The overall highest infection is among the Malays (79%), the least being among the Chinese (61.1%). The prevalence of Ascaris lumbricoides was highest in the 11-20 age group. The prevalence of Trichura was highest in the 51-60 age group, Ascaris and Trichuris infections is higher among the males but hookworm infection is higher among the females. 72.6% of the patients were infected with at least one type of helminth and 32.9% of the patients were infected with at least 2 types of helminths.


Total serum IgE level in patients with amoebic liver abscess and other parasitic infections. Total serum IgE level was determined by the radioactive single radial diffusion technique in blood donors, nurse-aid students with the stool positive and negative for parasites, and in patients with helminthic infections. A geometric mean of 445.1 IU/ml in the sera from blood donors was found. Patients with helminthic infections had significantly higher levels than the blood donors and the nurse-aid students with the stool negative for parasites. Intestinal protozoal infections did not cause an increase in IgE level.


Hallux-to-thumb transfer by microvascular anastomosis. The replacement of a missing thumb with a big toe transferred as a free vascularized composite graft is described. The anatomical basis relating to this transfer is described and the methods and the advantages and disadvantages of this as alternative thumb reconstruction are discussed. To the best of our knowledge, this procedure is the first of its kind to be undertaken in South Africa.


The effect of exercise in the asthmatic child - its clinical implications. Appropriate exercise will provoke an attack of bronchospasm in virtually all asthmatic children. Exercise-induced asthma can effectively be prevented by pre-exercise treatment with sympathomimetic drugs or sodium cromoglycate, and there is no reason why an asthmatic should not participate in sporting activities. Running at a steady pace for 6 - 8 minutes (submaximal effort) is the most asthmagenic exercise, whereas swimming is the least athmagenic.


Traumatic haemobilia: case reports.

Traumatic haemobilia: case reports. Injury to the liver may result in traumatic haemobilia. Three cases are reported, with differing clinical presentation resulting from different forms of injury. Haemobilia may present difficulties in diagnosis, particularly if there has been a long delay between injury and presentation. The use of selective hepatic arteriography as a diagnostic aid and treatment by hepatic artery ligation are outlined.


Angiolymphoid hyperplasia with eosinophilia: report of 3 cases. Angiolymphoid hyperplasia with eosinophilia is reported in 3 patients. This lesion is an uncommon reactive vasoproliferative disorder which presents with swellings in the dermis and subcutis. The aetiological agent which produces this tissue response is unknown. Clinically the disease follows a benign prolonged course without evidence of systemic involvement. The histological features consist of a prominent fibroblastic and proliferative vascular reaction associated with an inflammatory infiltrate in which lymphoid aggregates with germinal centres and eosinophils are conspicuous.


Successful management of oesophageal atresia type IIIa by oesophageal stretching: a case report. A case of oesophageal atresia type IIIa and anorectal agenesis is presented, in which stretching of the oesophagus resulted in successful delayed oesophageal anastomosis, thereby avoiding the need for colonic oesophageal replacement and thus greatly facilitating the repair of the anorectal agenesis. The literature is reviewed and it is concluded that every attempt should be made to effect oesophageal anastomosis, because the colon interposition procedure carries not only a high early mortality but also a high late complication rate.


Prognostic factors in acute myocardial infarction. The hospital courses of 882 consecutive patients with acute myocardial infarction admitted to the coronary care unit (CCU) during a 3-year period were evaluated. Their courses after discharge from the CCU were assessed with reference to the following serious complications which had occurred during their stay in the CCU; ventricular tachycardia or fibrillation, second-or third-degree heart block, pulmonary oedema, cardiogenic shock persistent sinus tachycardia, persistent hypotension, atrial flutter or fibrillation, or extension, or extension of infarction. Of the 494 patients (56%) with one or more of these complications, 38 (8%) died of cardiac causes in hospital after transfer from the CCU. Of 388 patients (44%) in the uncomplicated group, only 2(0,5%) died of cardiac causes after transfer from the CCU. The same patients were classified according to the Coronary Prognostic Index (CPI) of Norris. None of the 54% of patients with a CPI of less than 6 units died in hospital after transfer from the CCU. It is proposed that patients with a CPI of less than 6 units and with none of the listed serious complications during their CCU stay could safely be discharged from hospital earlier than is customary.


'Closed'-circuit (rebreathing) enflurane anaesthesia. The economics and advantages of non-rebreathing (semiclosed) versus rebreathing ('closed') circuit enflurane anaesthesia in spontaneously breathing patients, anaesthetized for ophthalmic procedures usually lasting less than 1 hour, were investigated. An average of 42, 5 ml liquid enflurane was used per hour of anaesthesia with the non-rebreathing apparatus, a figure close to the calcuated approximate enflurane usage for the first hour of anaesthesia (42,0 ml). Approximately half this volume was required for anaesthesia via the vaporizer out of circle (VOC) rebreathing system (19,0 ml/h; P less than 0,001). A further significant decrease resulted with the use of the vaporizer in circle (VIC) system (13,5 ml/h; P less than 0.001), but the surgical conditions provided by the latter were less satisfactory. Actual enflurane utilization with both VOC and VIC was greater than that expected for the first hour of anaesthesia (calculated approximate usage 15,0 and 11,0 ml/h respectively). Enflurane anaesthesia with the vaporizer out of circle is recommended for routine surgical procedures.


The binding of antituberculous drugs to normal and kwashiorkor serum. The protein binding of 6 antituberculous drugs--ethambutol, ethionamide, isoniazid, para-aminosalicylic acid, rifampicin and streptomycin--to normal and kwashiorkor serum has been investigated. The binding of these drugs was mildly decreased in kwashiorkor serum, but not to such an extent as to be of therapeutic importance, except for streptomycin and possibly para-aminosalicylic acid (PAS). With streptomycin there was a 15% increase in the free component in kwashiorkor serum, while with PAS there was a 12% increase in the free component. Of interest is the observation that rifampicin is predominantly bound to the gamma-globulin fraction, both in normal and in kwashiorkor serum. Secondary binding, predominantly to the alpha 1-, alpha 2-and gamma-globulin fractions, was seen quite commonly in kwashiorkor serum in association with diminished albumin binding.


Pyriform fossa carcinoma in South African Negro patients. Seven patients with pyriform fossa carcinoma who presented at Baragwanath Hospital during the period 1973-1976 are discussed. The value of positive contrast studies with special reference to laryngography is emphasized and the results are reviewed.


Acute of fulminating myelofibrosis.

Acute of fulminating myelofibrosis. Patients who run a fulminating course in association with histologically proven myelofibrosis are distinctly unusual, since the natural history of this entity is characteristically one of slow progression. Because of its rarity and proteam manifestations, acute myelofibrosis may easily go unrecognized. We report 2 such patients. In one, rapid clinical deterioration was dominated by spreading skin lesions, and in the other by refractory intravascular haemolysis. There was no splenomegaly in the first patient, and it was minimal in the second. Although  it is seen in frequently, it should be emphasized that myelofibrosis may arise de novo as an acute illness in which the usual degree of splenomegaly is absent.


Autopsy findings in mental patients.

Autopsy findings in mental patients. Over a 3-year period a total of 200 autopsies were performed on mental patients who died at Sterkfontein Hospital. Examination of the clinical history was made in each case. The main findings are described and discussed.


The cavernous haemangioma of the frontal bone. A case report. A case of haemangioma of the frontal bone is presented. The clinical presentation and the radiological features, which are diagnostic of this very rare condition, are given. Treatment is complete excision of the tumour, the macroscopical and microscopical appearances of which are discussed.


Sarcoidosis in South Africa. A comparative study in Whites, Blacks and Coloureds. One hundred and ten cases of sarcoidosis seen in Cape Town over a 7-year period (1969-1975) are reported. Seventy-one patients were Coloured, 25 Black and 14 White. The calculated minimum incidence of sarcoidosis in the Cape Peninsula is 23,2/100 000 population in Blacks, 11,6/100 000 in Coloureds and 3,7/100 000 in Whites. Differences in the incidence, presentation, clinical and laboratory features in the three groups of patients are presented and discussed. The differences between Whites and Blacks are similar to those reported from the USA, and the Coloured patients resemble the Blacks. The study clarifies some of the misconceptions about the incidence of sarcoidosis in South Africa, and documents the similarity of sarcoidosis in American and African Blacks.


[Smokers on Bloemfontein schools: profile and standpoint]. Primary prevention is now the first priority of research on smoking. A study was made of 1 505 children of 12 high schools situated in a conservative Afrikaans-speaking community in an attempt to determine the characteristics of the smoking and non-smoking groups. Of the total group 16% were smokers. The male/female ratio was 3:1. The mean age at which smoking commenced was 15,5 years. A positive relationship was found between the smoking habits of the smokers and those of their parents and best friends. The majority of pupils think that smoking is addictive. In addition, they believe that it is unhealthy and leads to poor sporting achievements. The great majority of smokers and non-smokers agree that non-smokers do better at school. Fathers of both smokers and non-smokers do not favour the habit. Ninety per cent of the boys and 83% of the girls started smoking between 12 and 18 years of age. The critical age for a preventive programme is thus 11 years.


Alcoholics and the emergency ward. Part I. Clinical characteristics. A study of White and Black (Black, Cape Coloured and Asiatic) male alcoholics who attended the psychiatric emergency service unit at Groote Schuur Hospital, Cape Town, is presented. The psychosocial and clinical characteristics are described and compared. In addition, the associated physical and psychiatric morbidity is tabulated.


Intussusception in haemophilia: a case report. A case of intussusception in a haemophilic boy is described. The presumed cause was an intramural haematoma, which resulted in an ileocolic intussuception. This appears to be the first reported case which has been reduced by barium enema. It is suggested that this method, together with factor VIII replacement therapy as soon as possible after the development of symptoms, is the treatment of choice.


Aid to families with dependent children: an overview, October 1977. In 1977, reorganization of the Department of Health, Education, and Welfare brought together in the Social Security Administration three major income-maintenance system--old age, survivors, and disability insurance; supplemental security income; and aid to families with dependent children. These are distinct and separate programs differing in purpose and in methods of financing and administration but often serving different members of the same household. The Federal-State program for aid to families with dependent children program (AFDC) is a grant-in-aid program and in many ways reflects the local policies in the 54 States and jurisdictions in both administration and levels of payments. This article outlines its national structure and variations in the program and describes how this cash assistance program operates to provide income for more than 11.2 million needy recipients in 3.6 million families, including almost 8 million children. In May 1977, program payments totaled about $840 million a month.


Emotional reactions of patient, family, and staff in acute-care period of spinal cord injury: part 1. In the Spinal Cord Injury Center at New York University Hospital, designed for optimal application of acute-care methods to the newly spinal cord injured, social workers have had the opportunity to observe the various emotional reactions of patients, family members, and staff during the crisis period. Four different types, or stages, of reactions have been identified: shock, denial, anger, and depression. Description and analysis of these stages are presented here with implications for treatment, as well as their significance in the long-term rehabilitation period that usually follows. Part 1 of this paper presents introductory material and description of the patients' reactions. Part 2, in the succeeding issue, will present reactions of family and staff.


A preventive program for bereaved families. The bereaved are a population at high risk for the development of subsequent emotional and physical illness. This paper describes a preventive program for families of cardiovascular surgery and oncology patients facing possible or inevitable death. The purpose of the program is prevention or redlction of the negative consequences of unresolved grief. The social worker's prior relationship with the family is used to provide advance preparation for possible or anticipated death, immediate intervention at the time a death occurs, preparation for the course of the normal grief reaction, and outpatient follow-up. The response of the bereaved has indicated that the service is effective in facilitating adjustment to the death of a family member, and the program has been adapted for other patient populations.


The intensive care unit: social work intervention with the families of critically ill patients. Hospital intensive care units can be a significant practice area for social workers. Nowhere are families in more obvious crises than when faced with the life-threatening illness of a significant other who may be unresponsive and dependent on a frightening array of highly technical equipment. Using the crisis model for their intervention, social workers can significantly lessen the trauma experienced by these families. Additionally, they can develop other supportive hospital resources such as family groups and volunteer services to help meet their needs.


Advantages of multifamily therapy for families of psychiatric inpatients. This paper considers the effectiveness of multifamily therapy as a treatment for families of emotionally ill patients who are hospitalized. Multifamily therapy groups on two sections of the C. F. Menninger Memorial Hospital are described, with special reference to variations in the criteria for inclusion of members. Initial findings of a limited study of one of the groups suggest a high degree of agreement among parent-members as to the ameliorative effect of this type of therapy, notably its capacity to assuage feelings of isolation.


Social work in health care in the next ten years. The social worker in health settings in the future will have more medical knowledge that affects his practice, be a more active psychosocial counselor, and be prepared to work in group practice that includes a number of disciplines. The social work department of the future will be organized in a more decentralized fashion, and will develop stronger links to other clinical and administrative departments within the medical center, to departments of social work of other medical centers, and particularly with community groups outside of the hospital. The department will need to assign manpower expertise in such areas as knowledge of changing social and welfare systems, legislation affecting programs, as well as in research, computerization, data gathering, and retrieval.


Social work education for health care practice. The probable future developments in social work education for health care practice are viewed from a systems perspective. The developing needs of social work in health care are examined within the context of the developing needs of the broader field of social work practice, since changes in this larger system cannot but impact upon the health care social work subsystem. Similarly, education for health care social work practice is seen within the perspective of the broader system of social work education for practice in general, because developments in this larger system determine the directions that will be taken by the smaller system of educational training. The interfacing of the two systems, social work practice and social work education, is examined.


A multimodel approach to collaborative practice in health settings. Health care professionals, under growing pressure to improve the effectiveness of their efforts, are giving increasing attention to interprofessional processes. While many aspects of collaboration have been studied, insufficient attention has been directed to the problem of how the characteristics of the organizational environment in which the collaboration takes place shape its form and process. The authors believe that the environment of the hospital indicates need for a multimodel approach to collaborative practice, and provides clues to its implementation.


The control of cell proliferation by preformed purines: a genetic study. II. Pleiotropic manifestations and mechanism of a control exerted by adenylic purines on PRPP synthesis. When plated in medium containing 0.5 microgram/ml coformycin and adenosine (or adenine) fibroblasts were killed, even if pyrimidines were supplied. Measurements of N-formylglycine amide ribonucleotide synthesis showed that lethality is a manifestation of purine starvation. In the case of adenosine kinase deficient cells, growth was restored by hypoxanthine. The adenylic derivatives block only purine biosynthesis, presumably by inhibition of PRPP-amidotransferase. In this same medium, wild-type cells exhibited symptoms of PRPP deprivation: purine and pyrimidine syntheses were both shut off and HGPRT was simultaneously inactivated. The pleiotropic control by adenosine was abolished in adenosine-resistant mutants that behaved as PRPP "over-producers." These mutations conferred partial resistance to various toxic purine and pyrimidine analogs and preserved HGPRT activity in adenosine-containing medium.  This permits selection against these mutants. Evidence suggesting that adenosine kinase products may fulfill a specific function in the regulation of PRPP synthesis is discussed.


Metastasis of carcinoma of cervix uteri to convexity meningioma. A cerebral collision tumor in which a convexity meningioma was  invaded by a metastatic squamous cell carcinoma of the cervix uteri is described. This is the first time such a lesion has been reported to invade a cerebral meningioma. The patient lived three active years postoperatively until the lesion recurred. Her status then deteriorated, and she died five years after the operation. This was a longer follow-up than any among the other 17 cases of carcinomatous metastases to meningiomas found in the literature.


Technical adjuncts in neurosurgery.

Technical adjuncts in neurosurgery. Modifications of several surgical adjuncts are presented: a balanced microscope stand with mouthpiece and hand controls, a piston release operating stool, a support device for resting the surgeon's arms, a table mounted arm with coupling head for attaching self-retaining brain retractors, fish hook retractors, suction tubes, bipolar forceps, aneurysm clips and mobile tip mirrors. Although many of these changes are minor, they considerably facilitate microneurosurgical procedures.


Periventricular lucency in hydrocephalus on computerized tomography. The ventricular margin on computerized tomography (CT) was examined in patients with dilated ventricles. In childhood and adult hydrocephalus of various causes, periventricular lucency of several degrees was often detected in the frontal horn, when hydrocephalus had progressed to an advanced stage. Since the periventricular low density zone disappears in a short time after a shunting operation, together with a reduction of the ventricles to normal size, the lucent zone around the ventricles may represent an increase in water content in periventricular white matter. This is consistent with periventricular edema, rather than loss of lipids and proteins.


Closed needle biopsy in the diagnosis of intracranial mass lesions. A retrospective study was performed on 54 patients with intracranial mass lesions who underwent closed needle biopsy using freehand and stereotactic biopsy techniques. A diagnosis of brain neoplasm was established in 44 of 54 patients, and nonneoplastic abnormalities were discovered in an additional six cases. Permanent neurologic worsening was noted in two instances following biopsy, and a single patient died as a result of the procedure. Closed needle biopsy, particulary when done stereotactically, appears to be a resonably safe and efficacious means of establishing a tissue diagnosis in carefully selected patients suspected of harboring a deep-seated supratentorial cerebral neoplasm.


Giant spinal extradural cyst.

Giant spinal extradural cyst. A case of giant extradural cyst in a 13-year-old girl is described. The cyst was formed by the arachnoid membrane which extruded through a wide lumbar dural defect. It extended from the midthoracic region down to the sacral canal. At operation a large portion of the cystic wall was removed, but the dural defect was not repaired. Two spino-peritoneal shunts were left in place to drain both the intradural and the extradural spaces. The treatment has proved successful during the 20 months that the patient has been observed.


Dural arteriovenous malformation in the anterior fossa. A case of dural arteriovenous malformation in the anterior fossa is reported. It first caused a subarachnoid hemorrhage and subsequently an intracerebral hematoma. Pertinent literature is briefly reviewed. Such malformations may be divided into three groups; those involving primarily the basal dura mater of the anterior fossa, the anterior portion of the falx, or the dura mater of the frontal convexity. Principal blood supply comes from the ophthalmic artery with an additional supply from the external carotid system. The treatment of choice is surgical excision with or without artificial embolization of the feeding arteries from the external carotid artery.


Microsurgical anatomy and dissection of the temporal bone. The topographic and internal anatomy of the temporal bone is reviewed with emphasis on the relationships important to the suboccipital, middle fossa and translabyrinthine surgical approaches to the internal auditory canal. The equipment and materials needed for temporal bone dissection in the laboratory are reviewed. A stepwise method of dissection for each of the three surgical approaches to the internal acoustic meatus is outlined for both the dry and wet temporal bone.


Unilateral Raynaud's phenomenon in the hand and its significance. Eighty eight cases of unilateral Raynaud's phenomenon of the hand were studied. The condition in most is progressive and should be treated early--before irreversible changes occur.


Macroamylasemia.

Macroamylasemia. Macroamylasemia, characterized by hyperamylasemia and a normal urinary amylase, has no known specific clinical symptoms. The disparity in serum and urinary amylase levels is due to a macromolecular amylase complex too large for glomerular filtration. This syndrome is presented in a patient with cholecystitis and a partial small bowel obstruction accompanied by persistent pre- and postoperative hyperamylasemia with proven macroamylasemia. The renal amylase clearance to creatinine clearance (CAM/CCR) ratio confirms this hyperamylasemic entity.


Intracaval breakage of umbrella filter.

Intracaval breakage of umbrella filter. This is a case report of the breakage of an umbrella filter 2 years after it had been inserted into the inferior vena cava of a young, active woman. The possible causes of the breakage are discussed. The authors feel that metal fatigue of the ribs of the filter was the most likely cause of the breakage. The varying degrees of intracaval pressure resulting from the normal physical activity of this patient could explain the metal fatigue.  the potential dangers of this complication, as well as of other complications associated with the use of this type of device, also are discussed. The authors feel that the age and the likely subsequent physical activity of the patient are important factors to be considered when choosing this modality of treatment for pulmonary embolism.


Congenital alacrima.

Congenital alacrima. A sixteen-year-old black male with congenital alacrima and deficient salivary secretion demonstrated evidence of keratoconjunctivitis sicca. The workup revealed elevated immunoglobulins and histologically normal lacrimal and salivary glands, but there was deposition of amyloid in the conjunctival stroma. The differential diagnosis of the dry eye is discussed.


Surgical or conservative treatment in hiatal hernias in children: a new decisive parameter. The authors have investigated the role of gastric acidity in the evaluation of cardiohiatal anomalies. Results are given of maximal gastric acid (MAO) investigations made in 155 children. Children in whom postural therapy failed and those with an ulcerlike syndrome have much higher MAO values than does the group who responded well to postural therapy and to a control group. Hyperacidity indicates a high probability of a poor response to postural therapy. Therefore measurement of gastric acidity is advisable in all patients with hiatus hernia, and early surgical therapy should be recommended in those with hyperacidity.


The effect of oxidized regenerated cellulose on experimental intravascular infection. Two groups of dogs had aortotomies and insertion of a Teflon patch. One group had the area of the aorta with the patch wrapped with oxidized regenerated cellulose (ORC); the other group served as a control. Both groups of animals were infected with S. aureus intravenously immediately after removal of the aortic clamps. The animals which had ORC wrapping of the aorta had significantly lower bacterial counts at the time of death than did the untreated group. This was measured from an hour after challenge up to 30 days.


Hydatid cyst of the orbit.

Hydatid cyst of the orbit. When echinococcosis (hydatid disease) attacks the orbit, surgical treatment is required. Although complications of the transcutaneous approach have been disastrous, a lateral orbital approach, removing the ectocyst from within the capsule, has been successful. Epidemiological, clinical and pathological features of 11 cases of echinococcosis of the orbit are described, and the recommended surgical procedure is outlined.


Hepatic support with hepatocyte suspensions in a permeable membrane dialyzer. Hepatic support by whole liver, liver slice, or hepatocyte perfusion is unsatisfactory. A new concept of support with circulating hepatocytes on one side of a cuprophan membrane and blood from an anhepatic pig on the other was evaluated in 19 dialysis experiments. Levels of pyruvate metabolism and oxygen utilization were similar to those obtained when liver cells in a centrifuge are perfused with oxygenated plasma. Of six anhepatic pigs given late hepatic support, five showed neurologic improvement. One had concomitant improvement in electroencephalographic results. A membrane hemodiolysis unit in which hepatocytes circulate against blood from an anhepatic animal is the most suitable extracorporeal liver support unit described so far. Its simplicity allows repeated and prolonged use.


Hodgkin's disease complicating Crohn's colitis. A case of Hodgkin's disease involving an area of Crohn's colitis in a patient with a 20-year history of inflammatory bowel disease is described. The coexistence of Crohn's disease and Hodgkin's lymphoma has not been reported previously. The possible relationship between gastrointestinal lymphoma and Crohn's disease also is discussed.


Acute reversible renal failure following jejunoileal bypass for morbid obesity: a clinical and pathological (EM) study of a case. A patient who underwent jejunoileal bypass for morbid obesity developed servere renal failure associated with hyperoxaluria and renal oxalosis. Renal function improved and oxalate excretion decreased following hemodialysis and restoration of gastrointestinal continuity.


Effects of portacaval anastomosis on liver and brain protein synthesis in rats. In vivo and in vitro protein synthesis was measured in livers from rats 3 weeks after a portacaval shunt (PCS) operation. A marked reduction in protein synthesis was observed, amounting to a 66 and 47% of inhibition, respectively. Above-saturation levels of amino acids were used in both conditions. The level of free exogenous amino acid was elevated consistently in the PCS animals 1 hour after isotope injection. In support of the data on liver protein synthesis, the incorporated radioactivity in serum proteins was reduced markedly. Heart muscle protein synthesis was unchanged while brain protein synthesis was inhibited when assayed in vivo. Neuronal cells showed a more marked inhibition of protein synthesis than did glial cells.


Extracranial to intracranial vascular anastomosis for occlusive cerebrovascular disease: experience in 110 patients. In an attempt to ascertain the value of extra- to intracranial arterial bypass for cerebrovascular disease, the general topic of bypass surgery is reviewed and the results of this procedure in 110 patients are analyzed. The feasibility of high patency rates of the anastomosis with acceptably low permanent morbidity and operative mortality rates is demonstrated. Lesions producing transient ischemic attacks which previously were considered to be inoperable or inaccessible can be bypassed by this procedure, and there appears to be a dramatic improvement in the symptomotology of virtually all patients. Patients with a mild stroke or "progressive stroke" also appear to benefit from bypass, but the erratic natural history of these entities precludes irrefutable substantiation of this conclusion. Patients with moderate-to-serve neurological deficits do not appear to be improved by this procedure. In our group of 20 patients presenting with transient ischemic attacks who have had more than 3 years of follow-up, only one patient has suffered a stroke and that was located in the opposite hemisphere.


Characteristics of inhibition of pancreatic secretion by isoproterenol. The effect of isoproterenol on pancreatic secretion stimulated by the octapeptide of cholecystokinin (OP-CCK) was studied in dogs with gastric and pancreatic fistulas. Special precautions were taken to prevent entry of gastric acid into the duodenum and reflux of duodenal content into the stomach. OP-CCK increased volume and the outputs of bicarbonate and protein from the pancreas. Isoproterenol inhibited these pancreatic responses to OP-CCK, and the degree of inhibition was dose related. Propranolol blocked the inhibitory action of isoproterenol completely. Analysis of data by Michaelis-Menten kinetics revealed that there was competitive inhibition of protein output with noncompetitive inhibition of bicarbonate output. The experiments show that isoproterenol inhibits OP-CCK--stimulated pancreatic secretion by a beta-adrenergic mechanism. The kinetic analysis suggests that the intimate mechanisms involved in inhibition of protein and bicarbonate output by isoproterenol are different.


Surgical management of the totally occluded carotid artery. Surgical revascularization of the completely occluded carotid artery was evaluated in 19 symptomatic patients who had recurrent episodes of amaurosis fugax or transient hemiparesis. Nine had complete internal carotid occlusion on arteriography and 10 had severe stenosis which had progressed to total occlusion by the time of surgical exploration. At operation irreparable fibrotic changes were observed in four patients, but in 15 a pattern of proximal focal obstruction with relatively healthy distal internal carotid vessels was observed. Thromboendarterectomy produced good back-bleeding in most of these and resulted in improved carotid flow after operation. Seventeen of 19 patients were relieved of symptoms. Two patients continued to have symptoms, but less frequently. There were no deaths after operation. Follow-up from 3 to 36 months showed no change from immediate postoperative results. This study suggests that carotid artery exploration and thromboendarterectomy should be considered when transient ischemic episodes are present despite complete internal carotid artery occlusion.


The use of velocity wave form analysis in the diagnosis of carotid artery occlusive disease. Velocity wave form analysis (VWFA) was carried out on 75 velocity tracings recorded from the common carotid artery with a continuous wave Doppler. Grouped according to clinical status, there were 20 young "normals" (I), 18 old "normals" (II), 15 stenoses of less than 50% diameter (III), 13 stenoses of greater than 50% (IV), and nine complete occlusions (V). Five of the nine dimesnions analyzed were found to be more discriminating than the others. Using these dimensions in an equation derived by discriminant analysis, the "score" of each tracing placed it into the appropriate clinical category with 95% accuracy. The accuracy rate of separating normal, stenosed, and occluded carotids was 100%. The accuracy of VWFA was limited (82%) only in discriminating between greater than and less less than 50% stenosis by diameter. Twenty-one of the 37 patients identified by VWFA as having carotid artery occlusive disease (CAOD) had normal supraorbital artery Doppler tests. Highly significant improvements in the velocity wave form of 10 carotid arteries were produced by endarterectomy.


The role of fibrinogen degradation products in the pathogenesis of the respiratory distress syndrome. Pulmonary dysfunction in awake rabbits was induced by intravenous infusion of a highly purified human fibrin split product (fragment D). The dose of infused fragment D was chosen to achieve observed plasma concentrations of fibrin split products in hospitalized patients with severe burns or trauma (about 100mug of FSP/ml of blood). Four hours after infusion, the animals displayed a clinical and pathological pattern which closely resembled post-traumatic acute respiratory distress syndrome, including hypoxia, hypocarbia, thrombocytopenia, increased pulmonary capillary permeability to albumin, interstitial edema, hypertrophy of alveolar lining cells, and intra-alveolar hemorrhage. In vivo production of fibrin split products by infusion of thrombin with induction of secondary fibrinolysis produced similar pulmonary changes, although intravascular clots and platelet aggregates also were prominent. Infusion of human fibrinogen and human albumin at identical doses failed to induce pulmonary dysfuction. The results suggest that fibrin split products (fragment D) alone are toxic to the respiratory system and may contribute to the development of acute respiratory distress syndrome in severely traumatized or burned patients.


Congenital intrinsic duodenal obstruction: a twenty-five year review. From 1951 through 1975, 72 patients with congenital intrinsic duodenal obstruction were seen at the Childrens Hospital of Los Angeles. The survival rate was 55% during the first 15 years of the study, but this has increased to 88% during the last 10 years. Factors important to this increased survival rate include: earlier diagnosis and expeditious preoperative workup; expert administration of anesthesia; improved surgical technique with a greater awareness for common pitfalls, such as associated duodenal diaphragm or distal bowel atresia; frequent use of gastrostomy; use of parenteral nutrition; and better intensive nursing care.


Temporal artery catheterization for arterial access in the high risk newborn. The hazards of umbilical artery catheterization necessitate the adoption of an alternate arterial cannulation site for monitoring arterial pressure and oxygen tension in the critically ill newborn. A newly developed method of catheter placement in the temporal artery not only provided arterial access for substantially longer than that reported for radial artery cannulation, but more than 50% of the infants in which it was performed weighted less than 1500 grams. Close adherence to the technique of arterial cannulation and catheter fixation is essential for prolonged arterial access. The method involves (1) Doppler location of the temporal artery, (2) a 3 mm transverse incision directly over the vessel, (3) bevel-down insertion of a winged hub teflon catheter with inner needle stylet, (4) securing the catheter with suture and collodion, and (5) maintenance of catheter patency with a constant infusion of heparinized solution. Temporal artery cannulation using this technique has been performed thus far 115 times in 100 infants with severe respiratory distress. The patients weighed between 540 and 3900 grams. Catheters remained operational for an average of 6.5 days (8 hours to 23 days), with 62% of all catheters providing arterial samples for more than 5 days. The cannulas worked well for arterial pressure monitoring, and pulse contour matched that of the umbilical artery in infants with catheters in both vessels.


The mechanism of postshunt liver failure. To determine the influence on postoperative hepatic mass, body weight, ammonia clearance, hepatic urea cycle enzyme activity, and hepatic protein metabolism, 59 dogs were divided into six experimental groups: sham operation end-to-side portacaval shunt, mesocaval shunt with subsequent end-to-side portacaval shunt, distal splenorenal shunt, caval left portal shunt, and portal venous seqregation with juglar vein interposition. Compared to total shunt, selective diversion of portal blood from the liver produces less postshunt liver atrophy, less body weight loss, improved maintenance of urea cycle enzyme activity, improved ammonia tolerance, and less decrease in hepatic deoxyribonucleic acid (DNA), ribonucleic acid (RNA), and protein content. Segregation of left from right hepatic lobes, in relationship to portal or systemic venous hepatic perfusion or in relationship to gastroduodenopancreaticosplenic or intestinal portal venous drainage, caused little change in enzyme or protein metabolism in respective hepatic lobes.


Mesenchymal solid tumors of the omentum and mesentery: report of four cases. Attention is drawn to the solitary solid tumors originating in the intra-abdominal mesenteries and in the omentum. These are rare lesions, each associated with an insidious onset and with a laterally ballotable mass frequently representing the only expression of disorder clinically. Some mesenchymal lesions have long eluded the pathologist and the surgeon in the frustration of firmly categorizing the predominant cellular involvement. At times there is an area of "spill-over" or of mixed tumor elements within the same lesion. Occasionally the lesion type is defined eventually only by recurrence and/or a lethal outcome attributable to tumor spread, regardless of its original cellular features. The management of four patients, two with omental tumors (leiomyoblastoma) and two with tumors of mesenteric origin (one patient with fibromatosis and the other with leiomyosarcoma), is presented from the 15 year experience of a large hospital facility. The uncomplicated diagnostic investigations are stressed as well as the essentiality of wide surgical resection to fully elaborate all morphologic features and to thwart recurrent disease in the future.


Tissue distribution and residues of beta-lactam antibiotics in normal dairy cows. Tissue residues and concentrations of benzylpenicillin, cloxacillin, ampicillin, amoxycillin, cephapirin, and cephacetrile were determined in normal dairy cows after parenteral administration of several forms of these drugs. Assay methods included the Sarcina lutea Kidney Test of Van Schothorst, the Bacillus subtilis BGA Tests at pH 6.0 and 8.0, the Escherichia coli Test and a Sarcina lutea Test performed at pH 8.0 of the agar, and specific quantitative assay methods. The E. coli test method demonstrated an insensitivity for the beta-lactam antibiotic residues. Identical results in residue testing of meat and kidney were obtained with the B. subtilis BGA tests and S. lutea test at pH 8.0, and these test methods replicated each other. The S. lutea Kidney Test was very often positive at times after treatment when the antibiotics were no longer detected in the meat. The qualitative and quantitative residue data from the renal cortex were higher than the data obtained from the muscle meat. The concentration relationship between renal cortex and muscle meat dependent on the formulation and type of drug used, and on the time of sampling after treatment. After treatment with products containing ampicillin trihydrate and procaine penicillin an unexpectedly long persistence of these drugs in the renal cortex was observed. It is suggested that, in the case of beta-lactam antibiotics, meat tests are more accurate indicators for the residue status of the carcass.


Studies on a number of erythrocytic enzymes and intermediate products of equine erythrocyte metabolism. The activities and concentrations of a number of erythrocytic enzymes and intermediate products of erythrocyte metabolism were determined in twenty-one normal standard-bred horses which were studied clinically and biochemically. These studies showed that equine anaerobic glycolysis is characterized by a biochemical pattern similar to that observed in human PK deficiency. The greater sensitivity of equine haemoglobin to oxidants is attributable either to low stability of GSH, which may be due either to the low activity of GR or that of 6PGD as observed in the studies. In addition, the saturation of GOT and GR with cofactor and apoenzyme respectively were determined.


Practical experiences with prostaglandins in heifers and dairy cows. This paper describes the extent to which utilisation of prostaglandins (PG) to achieve synchronisation of oestrus can influence certain economic results. Special attention is paid to the fertility status (FS) and calving index in dairy cows, where PG-treated groups are compared with untreated groups. With regard to these parameters a significant difference exists in favour of the PG treated group. In heifers the pregnancy rate after the first insemination has been determined in a PG treated group. The result compare very well with other published data. On large farms, where heat detection is poor, the routine use of PGs in the total herd is economically attractive. On those farms where the practitioner is involved in a fertility guidance system and where optimum heat detection takes place, the routine use of PGs in dairy cows would seem to offer advantages from a financial point of view.


[Superfoetation following artificial insemination in a ewe (author's transl)]. A case of superfoetation following artifical insemination in a ewe is reported. Estimation of the age of the lambs was based on the maturity of the liver, lung, kidney, brown adipose tissue and skin, showing a difference in gestational age of approximately thirty-six days. The possibility of spontaneous superfoetation as well as that of a second fertilization after artificial insemination is discussed.


Association between HLA-B7 and allergic reactions to insulin in insulin-dependent diabetes mellitus. Forty-four cases of insulin-dependent diabetes mellitus with cutaneous allergic reactions to insulin were typed for HLA-A and -B antigens. HLA-B7, which commonly is negatively associated with insulin-dependent diabetes mellitus, showed a positive association with insulin allergy. A second antigen, HLA-Bw21 may also be positively associated with local insulin allergy. These data were discussed in relation to heterogeneity of insulin-dependent diabetes mellitus and to the existence of B7-associated immune response genes for allergic-immunoreactivity to insulin.


Frozen lymphocyte pools as technical and reference controls for lymphocyte transformation. Healthy individuals' peripheral blood lymphocytes show wide ranges of response to mitogens and allogeneic lymphocytes. When individuals' lymphocytes are pooled together, the responses of the pool are equivalent to the means of the responses of the lymphocytes which comprise the pool. Pooled lymphocytes retain their responsiveness when stored frozen, and may be used as standard responding cells in lymphocyte transformation tests, but are not suitable controls for antigen-induced lymphocyte transformation.


Effects of isometric handgrip exercise on coronary sinus blood flow in idiopathic cardiomyopathy. Coronary sinus blood flow (CSBF) was measured by the dye dilution method in 18 patients with idiopathic cardiomyopathy including 13 with hypertrophic type and 5 with congestive type, and the capacity for increasing CSBF in response to handgrip exercise was studied in 14 patients. CSBF at rest ranged from 41 to 236 ml/min/M2. Average CSBF of 114 +/- 12 ml/min/M2 (112 +/- 14 in hypertrophic type and 119 +/- 25 in congestive type) was significantly larger than control value of 77 +/- 6 presented previously (p less than 0.01). Handgrip exercise at 30% maximal effort for 3 min resulted in the increase in CSBF, averaging 23 +/- 8 ml/min/M2 (22 +/- 8%). However, in about one-half of cases, the percent increase in CSBF was much smaller than the percent increase in effort index which represents myocardial oxygen demand. The change of CSBF was not correlated with the changes of left ventricular systolic pressure, cardiac output, and stroke work. The diminished response of CSBF to isometric handgrip exercise was ascribed to the decreased coronary vascular reserve in this disorder.


Effect of dialysis treatment on glucose metabolism in uremic patients. To study the carbohydrate metabolism in uremic patients, the intravenous glucose tolerance test (iv GTT) and insulin sensitivity test were investigated on 69 patients with chronic renal failure, 27 of whom were under the dialysis treatment. 1) Abnormal K-values averaging 1.05 were obtained in uremic patients (creatinine clearance less than 20 ml/min). 2) Carbohydrate intolerance in uremic patients was corrected with regular dialysis and the improvement was correlated with the duration of dialyses. 3) The mechanisms of improvement in carbohydrate metabolism were different between the short-term dialysis group (less than 12 months of dialysis) and the long-term group (more than 12 months). Enhanced secretion of insulin seemed to be the main cause of this improvement in the former, while the correction of impaired sensitivity to insulin in peripheral tissues in the latter.


The significance of candiduria.

The significance of candiduria. Candida, which is not detectable in the urine of healthy individuals, was found in 6.5% of patient's urine. Most of the patients developing candiduria had higher-titered circulating antibody to the fungus than healthy persons did. There existed a definite relationship between the serum antibody titer and the duration of candiduria. These two variables reflected the status of the patient.


Potassium levels in the aqueous and vitreous humor after death. It appears possible to utilize the potassium in the aqueous humor as well as the potassium in the vitreous humor for the estimation of the postmortem interval, especially if the factors relating to the body temperature are taken into consideration.


Adsorption of mercury to urinary cells or particles. Urine of a young healthy man was added with varying amounts of mercuric chloride, incubated for 10 to 375 min, and separated into supernatant solution and precipitate by centrifugation at 105,000 X g for 60 min. Percentage of mercury amount in precipitate increased with the increase of mercury amount added. But this adsorption of mercury to urinary cells or particles could not completely account for the amount of mercury in human urine reported (Suzuki and Shishido 1975). The hypothesis that desquamation of tubular cells is a route of urinary mercury excretion in man is still sustained.


Catecholamine metabolism in the patients with rheumatoid arthritis. The amount of urinary catecholamine of healthy subjects and patients with rheumatoid arthritis, particularly before and after synovectomy, was studied. (1) The urinary catecholamine of patients with rheumatoid arthritis showed a lower value than that of healthy subjects. The greater the amount of intraarticularly injected steroids was and the more severe the stage and class of rheumatoid arthritis were, the lower the level of adrenaline was and the more reduced the activity of phenylethanolamine-N-methyltransferase was. (2) The level of urinary noradrenaline in patients with rheumatoid arthritis was lower than that of healthy subjects, but there was no relationship between the level of noradrenaline and the amount of intraarticularly injected steroids. Considering that noradrenaline tended to approach to the normal level as the stage of class of rheumatoid arthritis was more severe, the level of urinary noradrenaline in patients with rheumatoid arthritis seems to reflect the existence of a certain compensatory system in the enzyme system of catecholamine metabolism rather than the influence of the adrenal cortex system. (3) The urinary catecholamine was decreased after synovectomy; especially, noradrenaline level was remarkably decreased. These results suggest that catecholamine plays an important role in the appearance of pain or other clinical signs in rheumatoid arthritis.


Activities of catalase in leucocytes and glucose-6-phosphate dehydrogenase in erythrocytes of hypocatalasemia and acatalasemia. Catalase activity in leucocytes was found to be half the normal value in hypocatalasemia and extremely low in acatalasemia. Glucose-6-phosphate dehydrogenase activity in erythrocytes was not significantly different between normal, hypocatalasemia and acatalasemia in three families of acatalasemia, but in one family lower activities than normal were found in hypocatalasemia and actalasemia erythrocytes. Other enzyme activities in blood, such as alkaline phosphatase, lactate dehydrogenase, glutamic oxaloacetic and glutamic pyruvic transaminases were not significantly different between normal subjects, hypocatalasemia and acatalasemia.


Changes in glucose tolerance and insulin response in subclinical diabetes after treatment. In this study, 121 patients who showed diabetic or decreased glucose tolerance and were treated with diet alone for one to fifteen years were investigated as subclinical diabetes. Glucose tolerance in these patients was improved or remained unchanged during the clinical course. Aggravation in glucose tolerance was observed in only seven cases. However, abnormalities in glucose tolerance were still found in 107 cases (88%) of the subclinical diabetes. Insulin response to oral glucose was investigated in 74 patients with subclinical diabetes. Delayed response and/or decreased response in the initial phase were demonstrated in 58 out of 74 patients (79%). No significant difference was observed in the insulinogenic index (ratio of insulin increment/glucose increment) at 30 min between the normal controls and either group with abnormal glucose tolerance. Diabetic retinopathy, including microaneurysm, was detected in 25 out of 109 patients with diabetic glucose tolerance. Abnormal insulin response, delayed and/or decreased, was demonstrated in 13 of 16 patients with diabetic retinopathy (81%). These results indicate the possibility that subclinical diabetes in the present study is a mild type of primary diabetes. In addition, it is suggested that abnormal response of plasma insulin to glucose, delayed and/or decreased, might be one of the prominent findings in diagnosis of diabetes mellitus.


Effects of various types of vagotomy on gastrin release and gastric secretion in dogs. Changes of serum gastrin and acid secretory responses to histamine, feeding and insulin stimulation before and after various types of vagotomy (TV, SV, SPV and SAV) were investigated in Heidenhain pouch dogs. The following results were obtained: (1) The acid secretory response to histamine slightly decreased after various types of vagotomy. (2) The responses of serum gastrin and acid secretion to feeding were elevated after various types of vagotomy. (3) The serum gastrin response to insulin was highly increased after SPV and TV, whereas the response was slightly increased and decreased after SV and SAV, respectively. The acid secretion in response to insulin was increased only after SPV, while it was decreased after the other types of vagotomy. These results led to the condition that there might be no correlation between serum gastrin and acid secretory responses to feeding and insulin after various types of vagotomy.


Light and electron microscopic study of skin lesions of patients with the hand, foot and mouth disease. Light and electron microscopic study was carried out on skin lesions of patients with the hand, foot and mouth disease (HFM.D) with special respect to virls localization in the affected skin. Light microscopic observations revealed a considerable number of eosinophilic inclusions in the nuclei of epidermal cells around the intraepidermal vesicles. Intracytoplasmic inclusions were not clearly observed. Crystalline arrays of virus particles were detected in the cytoplasmic portions of some epidermal cells by electron microscopy. These particles were approximately 20 nm in diameter. The skin lesions of the HFM.D are possibly a manifestation of virus proliferation in the epidermal cells.


Histopathological studies on the prognosis of biliary atresia. Liver specimens from 68 cases of biliary atresia were histologically studied in reference to postoperative prognosis. The histological findings were classified into 4 to 5 groups by the degree of fibrosis, bile duct proliferation, bile plugs, giant cell transformation, and intralobular cholestasis. Furthermore, morphometrical studies of interstitial area, bile duct (ductules), intrahepatic portal vein, and intrahepatic artery were done and correlated with the age of patients and with operative results. From this study, it was shown that 1) marked fibrosis (cirrhosis) and interstitial areas occupying more than 35% of the sectional area of the liver specimen, 2) severe ductular proliferation, shown by proliferated bile ducts occupying more than 20% of interstitial areas, 3) no or slight intralobular cholestasis and 4) marked interlobular cholestasis are considered to predict poor postoperative bile excretion.


A simple method of cell-mediated cytotoxic assay by postlabeling of tritiated thymidine. The cytotoxic reaction of effector cells on target cells was performed on cover slips which were set in a petri dish so as to be interposed from the dish surface through the bases of the slide glasses. After incubation, the target cells remaining on the cover slips were pulse-labeled with 3H-TdR for 45 min. Subsequently, the cover slips were removed from the bases, and dipped in cold 5% TCA to be freed from non-incorporated isotopes. The residual target cells adhering on the cover slips were counted without being removed. By this assay system, the specific or non-specific cytotoxicity of lymphocytes or macrophages was easily demonstrated with reliability.


PAO2-PaO2 relationship for the entire therapeutic range of oxygen in acute respiratory failure. The PAO2-PaO2 relationship was studied for the entire therapeutic range of oxygen in patients and animals in acute respiratory failure. The method is based on the assumption that the steady state values of PaO2 may be obtained as a mean of the two PaO2 values at an identical F1O2, one obtained 6 min after the F1O2 was raised from a lower level, the other obtained 6 min after the F1O2 was reduced from the higher level. We found that the shunts were large in the low F1O2 range (170 mmHg and below), took a minimum value in the moderate PAO2 range (170 to 300 mmHg), and increased again in the high PAO2 range (300 to 700 mmHg). A similar pattern was observed in the animal experiments, two or more hr following experimentally produced produced aspiration pneumonitis. In contrast, the dogs with bilateral pneumothorax showed a pattern which followed the isoshunt line closely. It was concluded that patients with acute respiratory failure requiring artificial ventilation have two componenents of the pulmonary shunt, one parallel with and the other inversely related with the PAO2. Possible mechanisms for the former were discussed.


Effects of gastrointestinal hormones on the electrical and mechanical activity of the cat stomach. Effects of gastrointestinal hormones on electrical and mechanical activity of smooth muscle of cat stomach were studied. Spontaneous electrical activity of the antrum preparation consisted of slow waves with superimposed spike-like potentials. Phasic contractions occurred synchronously with the electrical activity. Pentagastrin, tetragastrin, pancreozymin and secretin increased frequency of slow wave component and amplitude of phasic contraction. Atropine and tetrodotoxin did not block the spike-like potential and slow wave component. Noradrenaline and verapamil blocked the phasic contraction. The excitatory effects of these gastrointestinal hormones were observed in the presence of atropine, tetrodotoxin and dibenamine, but not in verapamil. When the mechanical activity of the antral strips was depressed by caffeine or theophylline, the excitatory effects of gastrointestinal hormones were also suppressed. The excitatory effects produced by these hormones were potentiated by imidazole. These results suggest that gastrointestinal hormones have a direct excitatory action on the longitudinal smooth muscle of the antrum region and that the excitatory action is associated with phosphodiesterase activity and intracellular cyclic AMP content.


Effect of plasma-cholinesterase preparation on the phase II block of succinylcholine chloride in man. The effect of enriched human plasma-cholinesterase preparation on the phase II block of succinylcholine chloride was studied in man during anesthesia and surgery. Intravenous administration of 8 esterase units/kg of plasma-cholinesterase did not show any discernible effect on the phase II block of succinylcholine chloride, while edorphonium 10 mg clearly antagonized the block. The finding of the present study suggests that the preparation may be ineffective for patients with a prolonged apnea following the administration of succinylcholine chloride.


Results of surgical treatment for intrahepatic gallstones. On the basis of the results of our surgical treatment of 85 patients with intrahepatic gallstones, effective methods for surgical treatment of this disease were discussed. The operative mortality rate for these patients was 10.6 percent. Most of the fatal cases had long duration of symptoms and showed evidence of hepatic fibrosis or biliary cirrhosis at the time of operation. The results emphasize that, in cases of long duration of symptoms, it is generally necessary to examine thoroughly prior to operation the presence or absence of liver parenchymal injury and to pay deliberate attention to minimizing operative intervention. Especially, in hepatic lobectomy, its indication must be scrutinized carefully assessing the condition of the patient. In our follow-up study, 80 percent of the patients were found living with almost no complaints, 5 patients having occasional bouts of cholangitic attack included 3 patients who had left the hospital having residual gallstones. Including these 3 patients, 7 of 9 patients with residual gallstones showed severe hepatic dysfunction. In general, indications of our operations for different types of patients with intrahepatic gallstones have been evaluated as satisfactory. For the favorable management of intrahepatic gallstones, two points are specially emphasized: thorough scrutinization of liver parenchymal disorder prior to operation, and long-term observation for care of survivors with residual gallstones.


Disinhibition of perigeniculate reticular neurons following chronic ablation of the visual cortex in rats. Effects of chronic ablation of the visual cortex (VC) were studied in the perigeniculate reticular neurons (PGR neurones) which were located in the thalamic reticular nucleus immediately adjacent to the dorsal nucleus of the lateral geniculate body and identified as the I-cells of Burke and Sefton. In rats with the intact VC the PGR neurons responded to single shock stimulation of the optic tract (OT) with bursts of spike spaced regularly. During the inter-burst period the neurons were inhibited, indicating that except for the primary spike burst, others were postinhibitory rebound excitation. In the VC-ablated PGR neurons there were no changes in the primary spike burst, but the remaining ones were very weak or sometimes missing, suggesting that the inhibition was poorly developed. With double shock stimulation of OT it was established that after showing the primary spike burst, the VC-ablated PGR neurons suffered a less intense inhibition than control. To a diffuse, sustained illumination, the normal PGR neurons showed on- and off- responses, whereas the VC-ablated ones were tonically activated during the presence of illumination. These findings were taken as indicating that the inhibitory mechanism for the PGR neurons were made less active after the VC had been ablated chronically.


Immunogenicity of rice dwarf virus-ribonucleic acid. Using rice dwarf virus (RDV)-RNA which was extracted from RDV and further purified by MAK-column chromatography, anti-RNA antibodies were produced in rabbits immunized with RDV-RNA antibodies were prods immunized with RDV-RNA-methylated bovine serum albumin complexes. The antisera, as analzyed by complement fixation, cross-reacted with synthetic double stranded RNAs (poly (A)-poly (U), poly (I)-poly (C)), but not with native or denatured DNA, rRNA, tRNA, 5 S RNA and nucleic acids from rice plants. RDV-RNA treated with heat or dimethylsulfoxide was markedly reduced in reactivity to the antisera. When RDV-RNA was digested with RNase A at low salt concentration, its complement fixation activity was abolished. In double diffusion tests, two different precipitation lines were demonstrated between the antiserum and RDV-RNA. One of the precipitation lines connected with those was formed between the antisera, poly (A)-poly (U) and poly (I)-poly (C). As regards immunoglobulin classes of the antibodies, one of the two rabbits employed had antibody activity only in IgG.


Pathology of lupus nephritis with special reference to the immunological bases of glomerular changes. Glomerular changes, and cellular and tissue responses of antibody-forming organs in 37 cases (20 cases with nephrotic syndrome and 17 cases without the syndrome) of systemic lupus erythematosus (SLE) were described. The glomerular changes were classified into 3 types, i.e., proliferative glomerulitis, membranous transformation, and wire-loop lesion from the standpoint of glomerular functional structure and its alterations. As to the responses of antibody-forming organs, hypoplasia of myeloid tissue, atrophy of lymph follicles of spleen and lymph nodes, atrophy and decrease in numbers of lymphocytes of thymus, proliferation and infiltration of plasma cells and plasmocytoid basophilic mononuclears, and proliferation of basophilic reticulum cells at the cost of differentiated antibody-forming organ tissues of bone marrow, spleen, lymph nodes, etc. were noted. Immunological bases of glomerular changes were considered and discussed in the light of pathological findings of SLE presented here and suggestions from experimental pathological studies in this field. Pathogenic roles of antigen-antibody complexes as well as anti-glomerular basement membrane (anti-GBM) antibody were considered in relation to the histologic manifestations of glomeruli in SLE or lupus nephritis.


Pulmonary arterial pressure-flow characteristics in atrial septal defect: comparative study with ventricular septal defect and patent ductus arteriosus. Pulmonary arterial pressure-flow relation was studied in 142 patients with artrial septal defect (ASD) and was compared with that of 139 patients with ventricular septal defect (VSD) and was compared with that of ductus arteriosus (PDA). The incidence of pulmonary arterial mean pressure (PAm) over 25 mmHg was 21 percent in ASD, 36 percent in VSD and 43 percent in PDA, and that over 40 mmHg was 3 percent, 23 percent and 19 percent, respectively. Large left to right shunt over 50 percent was found more frequently in ASD (58 percent) than in VSD (22 percent) and PDA (30 percent). When patients were separated into 2 groups at a PAm of 40 mmHg, lower pressure group showed a positive correlation between PAm and left-to-right shunt in each disease, although the correlation was poor in ASD (r equals 0.23) as compared with VSD (r equals 0.49) and PDA (r equals 0.47). The slope of the regression line was less steep in ASD (0.08) than in VSD (0.17) and PDA (0.14). It is considered that pulmonary hypertension in ASD develops on the basis of pulmonary vascular changes caused by prolonged hyperkinetic circulation.


Echocardiographic features of straddling mitral valve. A case of straddling mitral valve associated with double outlet right ventricle and coarctation of the aorta is presented. Radical operation (Jatene's procedure) was performed under the diagnosis of complete transposition of the great arteries associated with coarctation of the aorta. The patient could not survive the operation. Autopsy revealed that both of the great vessels originated in the right ventricle (double outlet right ventricle). In addition to this abnormality, some of the chordae of the mitral leaflet were attached to the right ventricular wall through the ventricular septal defect (straddling mitral valve). Echocardiograms recorded prior to the operation revealed feactures corresponding to the anatomical abnormalities, including that the anterior mitral leaflet moved far anterior to the ventricular septum. This is the first case of echocardiographic features of straddling mitral valve.


Pathological study of tracheal and pulmonary lesions in autopsy cases of congenital esophageal atresia. One of the major causes of death in infants with congenital esophageal atresia is the lung complication. Analysis of the Annual of Pathological Autopsy Cases in Japan from 1966 to 1969 revealed that the lung complications were seen in 81% of total cases. We have carried out a detailed histological study of the trachea and lung in 4 infants who died of congenital esophageal atresia. In three of them, ciliated epithelium of the trachea was replaced by stratified squamous epithelium and the alveoli were filled with numerous foamy cells. There were only a little inflammatory change in sections studied. The constant association of these two lesions suggests cause-and-effect relationship, and we are inclined to think that retention of foamy cells in the alveoli is due to the impaired mucociliary transport mechanism in the respiratory tract.


Clinical features and laboratory findings of vibration disease: a review of 300 cases. Clinical features and laboratory findings of 300 inpatients with vibration disease before and after treatments were reviewed. Having been using chain saws or pneumatic hammers for a long period, the patients were afflicted with Raynaud's phenomenon, numbness, pain or stiffness of fingers, pain of elbows and neck, stiffness of shoulders and lumbago. They had high incidences of complaints due to the disorder of the central nervous system, especially of the higher center of the autonomic nervous system; i.e. headache (52.0%), palmar hyperhidrosis (70.0%), forgetfulness (78.2%), fatiguability (61.3%), tinnitus (41.8%), impotence (55.1%), etc. Laboratory findings of the autonomic nerve activity tests, electroencephalograms and audiograms also suggested the disorder of the central nervous system. Treatments during three months had improved significantly the subjective symptoms and the objective findings (p less than 0.05 to 0.001). Thus, vibration disease should be considered as a systemic disease, including disorders of the central nervous system, especially of the higher center of the autonomic nervous system, and disturbances of the peripheral functions.


Sound spectroanalytic diagnosis of malfunctioning prosthetic heart valve. Sound spectroanalysis was carried out for diagnosis of malfunctioning prosthetic heart valves in 50 cases, which consisted of 31 mitral, 14 aortic, 4 mitral+aortic and 1 tricuspid valve replacements with the age ranging from 17 to 57 years. Types of prosthetic valves used in this series were Starr-Edwards silicon ball valves, metal ball valves, disc valves, Kay-Shiley valves, Smeloff-Cutter valves and a Björk-Shiley valve. The system used in this study consisted of a moving coil microphone, a preamplifier, a filter (160/24 db octave) and a sound spectrograph (Rion Co. S.G. (7). Contour sound spectrograms (SSG) were drawn and peak frequency, wave pattern and frequency-intensity curves were investigated as characteristics of implanted valvular function. Peak frequencies of valvular opening and closing sounds were recorded between 1800 to 5000 Hz and differed according to the types of prosthesis. In mitral+aortic valve replacements, valvular sounds of two prostheses were clearly separated and this finding was very useful for determining the prosthesis which fell into malfunction. Decrease in peak frequency of valvular sounds or abnormal wave patterns in contour SSG were observed in 9 cases (18%). Of 9 cases, 4 cases underwent re-replacement and 2 cases died of congestive heart failure. Operative or autopsy findings gave proof to the findings in sound spectroanalysis.


HLA antigens and toxoplasmic retinochoroiditis. HLA (Human Leukocyte-A) antigens of 20 patients with toxoplasmic retinochoroiditis were determined by the standard microlymphocyte cytotoxicity test to see if these patients have different immunogenetic backgrounds from the normal controls. The results showed that there were no significant differences between the patients and the normal controls.


Activities of superoxide dismutase and glutathione peroxidase in the red cells of Japanese acatalasemia blood. The activities of superoxide dismutase and glutathione peroxidase in the red cells of normal and acatalasemia bloods were compared. Superoxide dismutase activity in the red cells of Japanese acatalasemia blood was higher than in normal control, while glutathione peroxidase activity remained within normal limits. Cyanide sensitivity of superoxide dismutase in the red cells of acatalasemia blood was similar to that in normal control.


[Integrated treatment of the inoperable bronchial carcinoma (author's transl)]. The inoperable bronchial carcinoma tends to early formation of metastases. If the tumor responds well to different cytostatic drugs, chemotherapy is absolutely necessary. In this case, combined therapy has better results than monotherapy. We use chemotherapy prior to radiotherapy in order to prevent hematogenic extension of the disease and to ameliorate the receptiveness of the primary tumor. In order to avoid local recurrence it is necessary to submit the primary tumor and the mediastinum to radiotherapy. A focal dose of 3000 rd within three weeks is considered to be sufficient. This dose generally does not cause severe myelosuppression, so that the chemotherapy can be continued. A report is given on the provisional results of different chemotherapeutic combinations. Further studies, however, are absolutely necessary in order to be in a position to give recommendations of common validity.


[Radiotherapy of lymphogranulomatosis--relations between radiomyelitis and oncogenic alteration of the spinal marrow (author's transl)]. The authors compare the results of two methods of the upper and lower system irradiation in case of Hodgkin's disease with respect to the spinal marrow. The frequency of radiomyelitis is opposed to the frequency of Hodgkin-specific alterations of the spinal marrow. 74 patients were submitted to telecobalt irradiations the dosage of which was below the tolerances known for the spinal marrow. Two of them presented a radiomyelitis and two a paraplegia of Hodgkin in the irradiated region. One paraplegia caused by the formation of a tumor developed in a region next to the irradiation field; certainly this region would have been affected by a higher dosed large-field irradiation of the spinal marrow. The application of the large-field methods in 61 patients did not cause any radiomyelitis in spite of doses which were higher than the tolerance doses for the spinal marrow of Franke. Hodgkin- specific infiltrations of the spinal canal were also not observed. The large-field method can also be recommended because it seems to offer a larger therapeutic field between the risks of spinal Hodgkin manifestations and radiomyelitis.


[Optimized cross-section determination for treatment planning in radiation therapy (author's transl)]. A true scale cross-section of the body is an indispensable condition for the accuracy of treatment planning in radiation therapy. To this end, ultrasonic or computed tomography may be used. Advantages and disadvantages of these methods are discussed. By summarization of cross-sections from all positions appropriate for treatment the most authentic body contours are obtained as an optimal basis for irradiation.


[Dosimetry of negative pi-mesons (author's transl)]. Central axis depth-dose curves, isodose curves, and size of beam spot at various depth were measured in a water phantom at a pi- -beam suitable for radiobiological and radiotherapeutical experiments. Problems of measurement of the absorbed dose in the peak region of the depth dose cure are discussed.


[Angiographic diagnosis of small intestine carcinoids (author's transl)]. A report is given on two cases of metastasizing ileum carcinoid in which the arteriography of the superior mesenteric artery and the hepatic artery lead to a correct diagnosis while no clear result could be obtained by conventional X-ray examinations (gastrointestinal passage and Irigoscopy of the colon). In the first case, the vascular alterations in the lower ileum, combined with numerous hyper-vascularized metastases in the liver allowed to diagnose the primary tumor and to determine its type. In the second case, a correct diagnosis could be made alone bacuse of the specific vascular alterations indicating the carcinoid which was growing by infiltration (vascular star, missing parenchymatous charge, belated venous drainage, in the tumor region). In one case, a second primary tumor whose growth was accompanied only by little infiltration could be early diagnosed. All diagnoses were confirmed by surgical and anatomicopathological findings. In order to ameliorate the prognosis, bad until now, by an earlier diagnosis, arteriography should be used whenever a (metastasizing) small intestine carcinoid is suspected.


Effects of low-dose irradiation with x-rays and pi-mesons on embryos of two different mouse strains. The effects of two different kinds of radiation (X-rays and negative pions) on embryonic development of mice was examined. The application of a known radiosensitizer (lucanthone) combined with 13.5 rd whole-body irradiation on day 8 of gestation showed enhanced teratogenic action compared to treatment with each of the agents alone. The extent of intensification varied both with mouse strain and treatment, indicating possible differences in repair capacity and LET-dependency of sensitization effects. Strain differences were found in the incidence and type of chemical and radiation-induced malformations, which may be explained by different developmental stages at the time of treatment.


[Experimental examinations about the proliferation and radiotherapy after administration of Vincristin and Adriamycin (author's transl)]. Cytophotometric examinations of solid carcinomas of Ehrlich in mice don't show a considerable cyto-cinetic effect after administration of Vincristin. On the other hand, Adriamycin causes in the same tumor a significant stop in the G2 + M phase with a synchronization factor of 1,4 to 1,5 related to G2. The following experiment with the combined Adriamycin and radiotherapy demonstrates with a statistical significance lying about 5% that an immediate radiotherapeutic success can be obtained which is even increased by a partial synchronization. A considerably enriched G2 + M phase as a result of the administration of Adriamyzin is proven by a first cyto-cinetic examination of human cancerous tissue. A possible clinical therapy scheme is discussed.


Radiosensitization and radioprotection studies on Ehrlich ascites tumor. II. Experimental trial of lucanthone to enhance the radiosensitivity of the tumor. Lucanthone (miracil D) is reported to be carcinostatic and a radiosensitizer. But in our study lucanthone alone (70 mg/kg body weight) had no lasting effect on the Ehrlich carcinoma in mice. Based on mitotic studies, 4-day old ascites tumor was not sensitized to X-rays when pretreated with lucanthone. Tumor growth, evaluated as the average weight of solid tumors or the number of tumor cells in ascites bearing mice, was not significantly different between the group treated with X-rays only and the one treated with lucanthone plus X-rays. Thus lucanthone seems to enhance the radiosensitivity of certain cell types but not of the tumor tested. The orobable mechanism of action of the drug leading in some cases to enhanced radiosensitivity is presented.


[Influence of whole-body X-ray irradiation and 2, 4, 6-triethyleneimino- 1, 3, 5-triazine on the hypnotic effect of hexobarbital in mice (author's transl)]. The hypnotic effect of hexobarbital, measured in male NMRI-mice, was reduced during the first 24 hours after a unique or fractionated whole-body X-ray irradiation with 700 and 1400 R resp. 70 to 280 R and twelve hours after a unique intravenous injection of 16,0 mg tretamine per kilogram of body weight. Immediately after a unique injection of a high dose of tretamine and 24 hours after the last of four applications of 0,25 to 2,0 mg/kg which were repeated each after one day, the sleeping time after hexobarbital was prolonged. 24 hours after fractionated injection of tretamine (0,5 mg/kg each time), the concentration of hexobarbital in the brain showed a significant increase compared with the control animals. These results show that the decreased effect of hexobarbital in the early post-irradiation phase is based on pharmacodynamic processes while the increase of the effect produced by continued administration of tretamine can be explained by pharmaco-cinetic reasons.


[Metabolism and toxicity of therapeutic chelating agents. 15th communication: Effect of ca-DPTS and zn-DTPA on blood coagulatin (author's transl)]. Single subcutaneous injection of Ca-DTPA by a toxic dosage results with rats in a short-term moderate reduction of the plasma concentration of factors belonging to the endogenous coagulation system and of the prothrombin complex. Neither the temporary fibrinolysis nor the thrombocytopenia occurring later deeply affect coagulation as a whole. By fractionation of the daily dose or by continuous infusion of Ca-DTPA damage to the plasmatic coagulation system is not further increased, although the intensity of thrombocytopenia is enhanced which is miminum after single administration of the chelate. The platelet functions, on the other hand, are not influenced by Ca-DTPA. The much better compatibility of Zn-DTPA as compared to Ca-DTPA was fully confirmed also with respect to the hematological and coagulation parameters.


Changes of the antiheparin activity of the blood plasma and lymph in dogs after total irradiation. An increase was demonstrated of the antiheparin activity in the blood of rats after their total exposure to 200, 500 and 800 R and dogs exposed to 400 R. In the rats the increase of the antiheparin activity was directly dependent of the exposure used. The antiheparin activity increased up to 180 min after the exposure. In the irradiated dogs, there was also a strong increase in the antiheparin activity with a certain decrease 24 hrs after irradiation. A secondary increase was observed on the 7th, 10th and 13th days of the experiment. In the lymph of the irradiated dogs, the increase of the antiheparin activity was steeper than that in the blood itself. The results achieved could serve as a starting point for further investigations to answer the question of possible using these changes for diagnostic estimation of the biological degree of the radiation damage under different conditions.