Hemodynamics in arterial reconstructions of the lower limb. I. blood flow. In order to establish normal and critical rates for peroperative, arterial blood flow, measurements were performed on 230 ileo-femoro-popliteal arteries subjected to reconstruction for atherosclerosis. Mean, basal blood flow after reconstruction was 134, 254 and 372 ml/min in the s. femoral, c. femoral and c. iliac arteries in vessels remaing open. These flow rates increased to a maximum of 375, 822 and 975 ml/min after intra-arterial injection of 40 mg papaverine. Flow rates were significantly lower in operations followed by early failure. In successfully reconstructed arteries, the mean, basal flow was restored to normal, but flow amplitude was still reduced, diastolic backflow was rarely seen and the flow-response to intra-arterial papaverine was significantly less than in normal arteries. Critical flow rates could not be defined but the frequency of primary failure increased significantly when basal blood flow after reconstruction was less than 100 ml/min or the papaverine induced flow was less than 200 ml/min. Preoperative blood flow was found to correlate well with the primary results of the operation while correlation with late results was less evident.


Hemodynamics in arterial reconstructions of the lower limb. II. Blood pressure. In order to demonstrate common pressure gradients and peripheral arterial pressure in ileo-femoro-popliteal arteries before and after reconstruction for atherosclerosis, intra-operative pressure measurements were performed on 204 patients. Before reconstruction, the pressure differential was 44.3 mmHg in femoro-popliteal arteries and 29.0 mmHg in the iliac arteries. This was reduced to 8.4 and 4.1 mmHg by the reconstructions. In patients with femoro-popliteal disease, the pressure gradient was higher when gangrena or rest pain were present than when claudication was the principal symptom. When the iliac arteries were mainly involved, no such difference was seen. Postoperative gradients were slightly higher in arteries subjected to primary failure than in vessels remaining patent. The blood flow increase from intra-arterial papaverine injections accentuated existing pressure gradients and frequently disclosed gradients not manifest at basal flow rates.


Trauma, dextran 40 and metastasis formation after intravenous tumour cell injection in rats. Dextran 40 did not influence the formation of pulmonary metastases after intravenous tumour cell injection in untraumatized dextran non-sensitive Wistar rats. Trauma significantly increased the formation of metastases and treatment with dextran 40 enhanced this effect of trauma markedly. No definite explanation of the effect of dextran 40 on pulmonary metastasis formation when combined when trauma can be offered, but possible mechanisms are discussed.


Predictive value of liver scintiphotography for demonstration of metastases in malignant gastrointestinal disorders. In a prospective investigation, the predictive value of liver scintiphotography was evaluated in 107 consecutive patients operated on suspicion of intra-abdominal cancer. Scintiphotography was performed by means of a Pho/Gamma HP scintillation camera after intravenous administration of 99mTc sulfur colloid. The final diagnoses were obtained within 10 days after scintiphotography by laparotomy or autopsy. The predictive value of an abnormal scintiphoto was found to be 57%, and the predictive value of a normal scintiphoto was 91%. It is concluded that scintophotography is helpful in the preoperative evaluation of patients with suspected intra-abdominal cancer, especially in order to rule out the presence of liver metastases.


Choleretic effect of vasoactive intestinal peptide. Vasoactive intestinal peptide, VIP, was administered intravenously as 10-minute infusions, dosage 0.05 and 0.5 mug/kg/min, to anaesthetized dogs provided with common duct fistulas. When VIP was given to fasting animals, the output of bile, sodium and amylase increased significantly, the bile output by approximately 200% of the control. The biliary concentration of sodium was constant, while that of amylase decreased. When VIP was given to animals, which were fed before the experiment, the bile output was essentially unaffected. The two doses used gave equal peak responses, but the duration of the effect was doubled or trebled following the highest dosage.


Prophylactic cephalothin in gastrointestinal surgery. A prospective study was carried out to evaluate the effect of a strictly standardized, short-term prophylactic treatment with cephalothin (Keflin) on the incidence of postoperative wound infections in gastrointestinal surgery. Achieved levels of cephalothin activity in serum and interstitial water were studied, and the sensitivity of isolated bacteria at the end of operation and from septic wounds was defined. Patients were divided at random into treatment and control groups. The treatment group received 2 g cephalothin at the induction of anesthesia and another 2 g, 5 and 10 hours after the primary infusion. The control group remained untreated. The rapid infusion of 2 g cephalothin resulted in high initial serum levels, which declined rapidly. Equilibration between intraand extravascular compartments occurred about 60-80 minutes after start of infusion. At that time the infused dose resulted in a cephalothin level of about 30 mug/ml in ECV and plasma, or about 30% of the initial concentration. Despite the prophylactic infusion of cephalothin, the frequency of wound infection in treated patients was the same as in the controls. Subdivision of the material according to type of surgery performed did not reveal any difference between untreated patients and controls. No shift towards cephalothin-resistant strains was observed in isolates from septic wounds in the treatment group.


Parietal cell vagotomy. Localisation of the microscopical antral-fundic boundary in relation to the macroscopical. 88 patients, operated upon for duodenal or prepyloric ulcers with a parietal cell vagotomy, were investigated in order to define the macro- and microscopical boundaries between the antrum and fundus of the stomach. The macroscopical boundary was defined as the point on the minor curvature where the nerve of Latarjet intersects the stomach or gives off its antral branches. The microscopical boundary was determined by taking multiple biopsies from both curvatures at distances related to the pylorus and to the nerve of Latarjet. At the minor curvature, the microscopical boundary was found to be located within +/- 2 cm from the macroscopical in 93% of the cases. The distance between the microscopical antralfundic boundary and the pylorus was significantly greater (8.7 +/- S.D. 1.6 cm) on the minor curvature than on the major (7.5 +/- 1.8 cm). In terms of optimal, over- and underdenervation on the minor curvature, 47% were optimal, 24% over- and 25% underdenervated. In 4 cases the boundary was indeterminable. This underdenervation means an antomical limitation of the operation and is inevitable because further denervation would sever the innervation of the antrum.


Carcinoma of the gastric stump after operation for benign gastroduodenal ulcer. A series of 36 patients with gastric stump carcinoma is presented. The average time interval between previous operation and diagnosis of carcinoma was 28 1/2 years. The interval was greater with lower age at gastric resection. The stump cancer occurs at the same age, and gives the same symptoms, as gastric carcinoma in general. 17 of the 36 patients were treated by total, or subtotal, gastrectomy. Three patients lived more than 5 years, two of them without recurrence. With surgical treatment of gastroduodenal ulcers in younger patients, more physiological operation methods, such as selective vagotomy, should replace gastric resection, as this would probably reduce the risk of later cancer development. After a time interval of 15 years from gastric resection, all patients should be examined by X-ray and gastroscopy at regular intervals.


Intestinal hypertrophy after small intestinal bypass in the rat. Studies on methods and reversibility of changes. A jejuno-ileostomy was created in rats, bupassing 85--90% of the small intestine, by means of a self-emptying blind loop. Control animals were subjected to laparotomy and suture-making of vie intestinal segments. At the end of the experiments, intestinal wet and dry weight and villus height were determined in the five different segments of the small intestine taken from both experimental and control animals. After 2 weeks, a significant hypertrophy occurred in the functioning part of the small intestine of the shunt-operated animals, while an atrophy occurred in the blind loop. In a shunt-operated group of animals, the normal anatomy was re-established after 2 weeks and the animals were sacrificed 4 weeks later and compared with (a) control animals, (b) shunt-operated animals. In the re-operated animals, the hypertrophic changes disappeared and, except for the increased wet weight of one jejunal and one ileal segment (p less than 0.05), there were no significant differences in comparison with the control animals. The villus height did not differ significantly from that of the control animals, except for the second jejunal segment, whicntestine of the rat, developing during the 2 weeks after establishment of a jejuno-ileal bypass, are reversible within 4 weeks.


The influence of a chemical diet on the intestinal mucosa after jejuno-ileal bypass in the rat. Loss of functioning small intestine (by resection or bypass) is followed by adaptive hypertrophic changes in the remaining functioning part of the small bowel. These changes are usually referred to as "compensatory". The mechanism behind these changes is unknown. In order to clarify the importance of a chemically defined diet (Vivasorb) on the development of the hypertrophic changes, rats operated upon with jejuno-ileal bypass, excluding about 85% of the small intestine, were divided into two groups. One group was nourished with standard pellet food and the other with Vivasorb. Control animals with simple laparotomy were also divided into the corresponding two dietary groups. After 2 weeks, wet and dry weight per 3 cm intestine and villus height was determined. In both diet groups the result was hypertrophy of the functioning part of the small intestine and atrophy of the blind loop with significantly cahnged villus heights as compared with controls on the same diet. The results indicate that a chemically defined, virtually bulk-free diet is capable of stimulating the mucosa of the small intestine to develop compensatory adaptive changes in the rat.


Ureteric obstruction complicating Crohn's disease in the terminal ileum. Ureteric obstruction complicating Crohn's disease of the terminal ileum is reported in three patients. This complication is treacherous, since symptoms of urinary tract disease are mostly absent, as is laboratory evidence of urinary tract infection. It is concluded that inflammatory ureteral engagement should always be suspected in patients with Crohn's disease, particularly when located in the terminal ileum. A preoperative intravenous pyelography should be included as a routine procedure in these patients. The detection of ureteral obstruction is a strong indication for early operative treatment of the disease. Ureterolysis combined with intestinal resection is recommended. The ureteral involvement, which is most likely a late phenomenon of the disease, could provably be avoided if surgical treatment is instituted at an earlier stage of the disease.


[Tissue migration of neutrophil granulocytes in the course of antiproliferative treatment in Hodgkin's disease]. The ability of neutrophil granulocytes to mobilization in sterile inflammatory focus was studied in patients with Hodgkin's disease during treatment. Plastic chambers filled with patient's serum were used for this purpose. The migration ability of granulocytes in the group of patients was reduced already before beginning of treatment. It decreased even more 3 days after beginning of cytostatic treatment but on the 7th day the number of cells passing into the inflammatory exudate increased to values observed in healthy subjects. The observed changes were not correlated with fluctuations in the granulocyte count in the peripheral blood observed on the same days. It is suggested that the evaluation of migration ability of granulocytes to the inflammatory focus may provide better information about the defensive mechanisms of the organism than determination of the count of these cells in the peripheral blood.


[Effect of prednisone and typhoid vaccine on the size of systemic neutrophil granulocyte pool]. Changes of total granulocyte pool in the organism were evaluated after administration of prednisone or typhoid vaccine. For this purpose the unsaturated capacity of serum vitamin B12 binding was determined. After administration of prednisone the rise of granulocytes in peripheral blood was associated with a rise in the unsaturated capacity of vitamin B12 binding by the serum which was not observed after administration of typhoid vaccine. This observation confirmed the suggestions that corticosteroids not only mobilize the bone marrow reserve of granulocytes but prolong also their survival in the organism.


[Hematologic and surgical problems connected with splenectomy in elderly patients]. The authors carried out a clinical analysis of problems connected with splenectomy in elderly patients treated surgically at the Institute of Haematology in the years 1965-1972. Out of 24 patients aged above 60 years 12 were analysed clinically (8 females and 4 males). Splenectomy was done in these patients from haematological indications (haemolytic anaemia, thrombocytopenia, pancytopenia). In all these cases indications to splenectomy, the course of operation and postoperative period as well as late therapeutic results were assessed. The analysis of these elderly patients showed that the criteria of indications for splenectomy were the same as in other age groups. The choice of surgical method depended in these cases on the clinical and haematological findings, a lack of permanent improvement after conservative treatment, contraindications to immunosuppressive treatment and results of isotope investigations (particularly the values of the spleen-liver index). In most splenectomized patients there were no complications during the operation and in the postoperative period. In 2 cases only acute circulatory failure was observed immediately after the operation. Evaluation of late results showed that the effects of the operation were similar to those in other age groups.


[Osseous changes in Hodgkin's disease and cellular bone marrow infiltrations]. In 83 patients (40 females and 43 males) aged from 17 to 69 years belonging to 190 cases of Hodgkin's disease treated as inpatients in the Institute of Haematology in Warsaw in the years 1966-1974 radiological investigations of the skeletal system were done. In 17 cases (20.4%) bone changes were demonstrated appearing as rarefaction (9 cases), sclerosis (6 cases) or mixed (2 cases) changes. The changes were located most frequently in the spine, less frequently in the epiphyses of long bones and flat bones. All 17 cases with bone changes were qualified as IV clinical stage of disease progression. Radiological osseous changes were not pathognomonic and it was difficult to draw conclusions as to the mode of spread. Bone pains were present in 8 patients, including 7 with spinal changes. In some cases treated postmortem specific infiltrations were found in bone marrow.


Thoracic epidural analgesia III--prolongation in the early postoperative period by intermittent injections of etidocaine with adrenaline. In 38 patients who had undergone elective upper abdominal surgery, postoperative analgesia was obtained by thoracic epidual analgesia, prolonged by intermittent injections of 3.0, 4.0 and 5.0 ml, respectively, of 1.0% etidocaine with adrenaline 1:200,000. The spread of analgesia after repeated doses is given, as are also the incidences of incomplete analgesia and urinary retention. Signs of tachyphylaxis were noticed. Decreases in the systolic blood pressure were evident, especially after the first injections in the three groups investigated. The falls in blood pressure in the 5 ml group were so pronounced that this part of the study had to be terminated. Accumulation of etidocaine in plasma was noticed in all groups. The clinical implications of the method are discussed.


Jet ventilation for fiberoptic bronchoscopy under general anesthesia. An oxygen jet method ventilating patients during laryngoscopy has been applied to fiberoptic bronchoscopy. A 3.5 mm plastic tube 24.5 cm long was inserted into the trachea through the mouth. An intermittent jet of oxygen at 3.5 atm (50 psi) was applied to this tube using a 1.5 mm ID plastic catheter to ventilate the patient. Anesthesia was accomplished with intravenous thiamylal and Innovar. The patients were paralyzed with continuous succinylcholine. The technique has subsequently been used without complications in more than 1,000 patients. A fluidic ventilator was developed for delivering and controlling the oxygen jet. The airway pressure can be monitored continuously and, by the use of fluidic devices, the jet can be set to cut off automatically if the airway pressure is too high. The above techique for laryngoscopy with the fluidic ventilator was used in 28 patients undergoing fiberoptic bronchoscopy (Olympus 5.7 mm diameter). The airway pressure was continuously monitored with a line attached to the suction port of the bronchoscope. Arterial PCO2 ranged from 23 to 42 mmHg and PO2 from 105 to 325 mmHg. The high PO2 levels were maintained even during suctioning. General anesthesia for fiberoptic bronchoscopy can be performed using an endotracheal tube not smaller than 8 mm internal diameter (ID). The advantages of the oxygen jet technique are that it can be used in smaller patients and that the upper airway can be examined.


Anesthetic management of posterior fossa surgery in the sitting position. From the surgical aspect, the sitting position gives good surgical access to the operative site, improves venous drainage, gives a better view of facial area for monitoring evoked responses from cranial nerve stimulation and allows for better ventilation. Conversely, the sitting position can present complications such as air emboli, postural hypotension and serious cardiac arrhythmias due to surgical stimulation of cranial nerves and brainstem. This paper presents our clinical experience in 180 neurosurgical procedures on the posterior fossa in the sitting position. The standardized anesthetic technique consisted of narcotic, muscle relaxant, nitrous oxide and controlled ventilation. All patients were monitored with ECG, direct arterial and venous pressure, discontinuous blood gases, and expiratory CO2 and urinary output. Air embolism was detected via Doppler ultrasonic detector and evacuated through a right atrial catheter. Air was detected, visualized and aspirated in 45 cases for an incidence of 25%, with most episodes occurring early in the procedure. In 11 cases (6%) air was detected on closure. There were no deaths in this series. Fifty-eight patients (32%) had a 10-20 mmHg drop in blood pressure on reaching the sitting position, 19 became temporarily hypertensive (10.5%), and the remainder were normotensive. In 46 patients (25%), bradycardia developed during retraction-manipulation-stimulation of structures on or adjacent to brainstem as well as to cranial nerves. Surgical stress also accounted for the 13 patients (7%) having frequent premature ventricular extrasystoles. One case of profound hypotension and another case of virtual cardiac standstill were noted during the use of the bipolar electrocautery at or near the fifth nerve exit from brainstem. Additional hemodynamic data, the physiopathology, diagnosis and treatment of air embolism is discussed.


Anesthesia for cesarean section IV: placental transfer and neonatal elimination of bupivacaine following epidural analgesia for elective cesarean section. Epidural analgesia with bupivacaine was used for elective cesarean section, and repeated maternal and neonatal blood samples were collected over 24 h for calculation of drug concentration. A gas-chromatogrphic micro-method was used for the analysis. The aim of this investigation was to evaluate the placental transfer and the elimination rate of the drug. No signs of systemic toxicity were observed in any mother or child, despite relatively high blood concentrations. The fetal-maternal ratio of concentrations at delivery was higher than in previous studies, most probably due to the protein-binding characteristics of bupivacaine and the dosage used. The biological half-life of the rapid phase of elimination (alpha-phase) in the newborn was shorter than in the mother (P less than 0.002), indicating a more rapid distribution process. The half-life of the slow phase of elimination (beta-phase) in the newborn was of the same magnitude as in the mother, indicating that neonatal elimination processes of bupivacaine may be well developed at birth.


Anesthesia for cesarean section V: effects of enflurane anesthesia on the respiratory adaptation of the newborn in elective cesarean section. The new anesthetic inhalation agent, enflurane, is supposed to allow rapid induction and recovery. Experinece with this agent in obstetrics is limited. Enflurane was therefore studied in 14 pregnant women undergoing elective cesarean section. Its effects upon the respiratory adaptation of the newborn infants were followed during the first 3 hours, as judged by oxygen tensions and acid-base balance measurements in serial neonatal arterial samples. Results were compared with those from a previously studied group of women anesthetized with a barbiturate and nitrous oxide-oxygen. There were no differences with respect to oxygen tension. Carbon dioxide values in the enflurane group were higher than those in the barbiturate group. In comparison with the barbiturate group the enflurane group of babies had lower BD values, which is a sign of a better metabolic state post-partum. Mothers anesthetized with enflurane were satisfied with the method, especially for the post-operative period.


Arterial and venous blood lidocaine concentrations after local anaesthesia of the respiratory tract using an ultrasonic nebulizer. Arterial and venous blood lidocaine concentrations were intermittently measured in 15 bronchoscopy patients in whom local anaesthesia was induced by an inhalation technique. A DeVillbiss ultrasonic nebulizer model 3574 was used. The anaesthetic was 10 ml of 4% lidocaine without adrenaline. Blood concentrations were measured 5 min after commencement of inhalation, on completion of inhalation, and then after 10, 30 and 60 min. Statistically significantly higher concentrations were found in the arterial blood at the first two sampling times (P less than 0.01 and P less than 0.05, respectively). The highest average concentration in both arterial and venous blood eas reached 10 min after completion of anaesthesia. After 30 min, there was no difference between the arterial and venous samples; and after 60 min, the concentration was higher in venous blood. The highest individual concentration was 2.8 mug/ml in arterial blood and 2.1 mug/ml in venous blood, well below that reported to cause systemic toxic symptoms. Thus, the inhalation technique may be considered a safe means of inducing anaesthesia in the respiratory tract.


Complement-fixing antibrain antibodies in multiple sclerosis. Comparison of their occurrence in cerebrospinal fluid and serum. Cerebrospinal fluid (CSF) and serum samples from 40 multiple sclerosis (MS) patients and 48 control patients were examined by a microcomplement fixation test for the presence of antibodies against saline extracts of human brain. When tested with an IgG content standardized in 100 mg per 100 ml, 13 of the MS CSF and one of the corresponding MS sera were positive, whereas none of the control specimens were positive. The antibody was shown to be highly organ specific when tested against extracts of myocard, spleen, kidney and peripheral nerve. Chromatographic experiments showed the antibody to belong to the IgG class. It was concluded that the antibody was probably synthesized intrathecally in 12 and extrathecally in one MS patient.


Cerebral lactate, pyruvate and ATP concentrations, and arterial acid-base balance at various time intervals following bilateral carotid artery occlusion in normotensive and spontaneously hypertensive rats. Cerebral lactate, pyruvate and adenosine triphosphate (ATP), and arterial acid-base balance were measured in normotensive rats (NTR) and spontaneously hypertensive rats (SHR) at various time intervals following bilateral carotid occlusion. In SHR, a great and progressive increase in cerebral lactate and lactate/pyruvate ratio (L/P) ratio) during the first 5-6 hours after occlusion was followed by a gradual decrease as the time interval increased. Cerebral ATP in SHR decreased as cerebral lactate increased, and an inverse relationship was observed between lactate and ATP. On the other hand, in NTR, there were minimal changes in cerebral lactate and L/P ratio following carotid occlusion. These results suggest that bilateral carotid occlusion might cause severe ischemic damages of the brain in SHR, but not in NTR. The hemodynamic factor as a cause of cerebral ischemia in hypertensives is discussed.


Echo-encephalographic study of ventricular dilatation after subarachnoid hemorrhage, with special reference to the effect of antifibrinolytic treatment. Echo-encephalographic examinations were performed in 144 patients after subarachnoid hemorrhage. Ninety-three of the patients received antifibrinolytic treatment (AMCA). The width of the third ventricle could be measured in all the patients, and lateral ventricle measurements were obtained in 94 patients. Third ventricular dilatation developed in 78 patients (54 per cent), and lateral ventricle enlargement was seen in 55 patients (58 per cent of those examined). The incidence of third ventricle dilatation was higher in the AMCA-treated group (62.5 per cent) than in the non-treated group (39.2 per cent), and this difference was statistically significant (P less than 0.05). The hydrocephalus in most cases developed 2-3 weeks after the bleeding, and reached its peak within the first 2-3 months, with subsequent complete or partial normalization of the ventricular size. At later follow-up examinations 1-4 years after the bleeding, only nine patients had persisting dilatation of moderate or pronounced degree. There was no indication that the dilatation was more severe or pronounced degree. There was no indication that the dilatation was more severe or protracted in the AMCA-treated group than in the non-treated group. In 11 patients the hydrocephalus required a shunt-operation, but the frequency of shunt-operations was not significantly different in the two groups. It is concluded that although AMCA-treated patients in comparison with non-treated patients are exposed to a somewhat higher risk of complicating hydrocephalus after subarachnoid hemorrhage, this risk cannot at present be considered as any serious contraindiction to this sort of treatment.


Evaluation of short-term and long-term treatment of the narcolepsy syndrome with clomipramine hydrochloride. Clinical examinations, questionnaires, and 24- or 36-hour polygraphic recordings were performed on 21 adult patients with the narcolepsy syndrome to investigate the short- and long-term effects of clomipramine HCL. Cataplexy was improved by the medication, but tolerance was observed 4 1/2 months of treatment. Clomipramine HCL induced significant changes in the sleep EEG, chin EMG, and EOG. In two patients, clomipramine HCL caused a nocturnal myoclonia that produced insomnia. Sexual side effects were seen with clomipramine HCL, particularly in males. A combination of clomipramine HCL and L-Dopa apparently prevented this difficulty in one patient. A rebound of cataplexy was seen during the 15 days following withdrawal of the drug. Methysergide maleate was found to be ineffective on cataplexy in four patients.


Considerations on the morphogenesis of target and targetoid fibres based on morphometric investigations. A man of 68, who died from a second heart stroke had neurogenic atrophy of the legs. The anterior tibial muscle showed abundant target and targetoid fibres. Half a year prior to death he had increasing weakness and wasting of the legs. The morphometric evaluation of the target and targetoid fibres showed a considerable independence of the plane size of the single zones from the total gauge of the fibres on cross section. Only a small part of the variation in size of zone 2 (4%) depended on the size of the target, indicating that zone 2 cannot just be a passive product of a shrinkage and disappearance of the target, but that there must be an active process, which leads to the change in zone 2. The regressive development of the centrally demarcated fibrillar bundle (target) is regarded as secondary degeneration following interruption of the nutritional supply.


[Repercussions of hypothyroidism on the synaptogenesis of the rat cerebellar cortex: quantitative study of the thyroid hormone effect according to the age (author's transl)]. The corrective action of Thyroxine on the deficit of the synaptic density of the molecular layer of the cerebellar cortex was studed quantitatively, in the rat made hypothyroid by propylthiouracile (P.T.U.). In the normal as in the hypothyroid rat, the increase of the synaptic density does not extend over the fifth postnatal week. In the PTU treated animals, during the 2 first postnatal weeks, the administration of 0,25 mug/d during the third and 0.50 mug/d during the fourth postnatal week brings the synaptic density back to normal. In the PTU treated animals, during the 5 postnatal weeks, the administration during a week only of 0.50 mug/d of LT4 between 1 and 14 days or, of 1 mug/d between 15 and 28 days, increases, but does not return to normal the synaptic density. On the contrary, the administration of 1 mug/d of LT4 during 1 or even 2 consecutive weeks 28 days later, remains without effect on the synaptic density. After the end of the fourth postnatal week, the deficit of the synaptic density becomes irreversible.


Late changes in human sural nerves in Minamata disease and in nerves of rats with experimental organic mercury poisoning. The sural nerves of 2 human cases with Minamata disease and poisoned rats were examined histopathologically. Both showed similar findings: the myelinated nerve fibres were decreased in number, but small myelinated nerve fibres were increased: The latter were irregular in shape and their Schwann cells showed regressive changes, with high electron density of the cytoplasms and many glycogen granules. Onion bulb formation was not found. According to fibre diameter histograms, the ratio of small myelinated nerve fibres of 2-5 mum showed a high percentage. A large number of the small myelinated nerve fibres were presumed to be regenerated nerve fibres. These findings are different from other peripheral neuropathies and may be characteristics of the late changes of the sural nerve induced by organic mercury compound.


[Olfactory esthesioneurocytoma: ultrastructural study of a case (author's transl)]. One case of malignant tumour of the left nasal cavity is reported in a woman 56 year old, affected by the disease 24 years. Numerous recurrences appeared and various histological diagnoses were performed. At the last surgery, the tumour invaded the ethmoid and was a typical olfactory esthesioneurocytoma. By electron microscopy, mature ganglion cells with dense cored vesicles (neurosecretory granules) were densely packed. Neuritic processes with microtubules were rarely normal in size and their content was most often abnormal; furthermore dystrophic axons were noted in great number.


Spongy degeneration of the central nervous system in kittens. The paper describes the clinical and morphological features of a congenital neurological disease affecting two in-bred litter-mate kittens. The principal neurological features were ataxia and dysmetria. In one of the kittens light microscopy revealed widespread vacuolation of white and grey matter of the brain and spinal cord. Electron microscopy revealved intra-myelinic vacuolation and some expansion of the extracellular space. Neuronal, axonal and glial changes were not seen, nor was there evidence of myelin breakdown. The entity is compared with congenital brain oedema of calves and spongy degeneration of the CNS in man.


Ultrastructural changes in blood vessels of peripheral nerves in leprosy neuropathy. I. Tuberculoid and borderline-tuberculoid leprosy patients. Radial or superficial peroneal nerve biopsies of 6 patients with tuberculoid or borderline-tuberculoid leprosy and 6 control nerve biopsies were examined by electron microscopy. Endoneurial blood vessels showed histopathology in all the leprosy patients. Changes, in particular, involved the basement membrane in postcapillary venules and venules. Multilayered parellel basement membranes, with collagen and ground substance, formed a thick coat ("hyaline zone") around the vessels. It is suggested that the zone inhibits passage of nutrients and metabolites and, thus, contributes to or is the main cause of the local destruction of (unmyelinated) nerve fibres and the lack of nerve fibre regeneration observed in this type of leprosy. The perivascular zone, presumably, is produced by pericytes in response to defects in the "blood-nerve barrier" of endoneurial vessels. In granulomata of leprosy skin lesions, a perivascular zone was not present. The endothelium of endoneurial vessels, in affected nerves, generally was normal. Occasionally, however, gaps and fenestrations were seen and there were histological indications that leakage of blood plasma had occurred through the gaps and through the basement membrane of the endothelium. Occlusion of endoneurial vessels was found only in the oldest patient and the degeneration of nerve fibres generally observed thus is considered not to be caused by ischaemia. Histopathology in epi-and perineurial vessels was definitely less pronounced than in endoneurial vessels.


Prenatal diagnosis of soft-tissue malformations by ultrasound and X-ray. This study presents four cases of fetal soft-tissue malformations diagnosed during pregnancy by ultrasonic scanning and amniography. The series comprises two fetal teratomas, one case of fetal ascites, and one case of a partial mole with coexistent fetus. Diagnostic and differential diagnostic problems are illustrated by a fifth case where the final diagnosis was a big maternal ovarian cyst-adenoma coexistent with a normal fetus.


Serum alkaline phosphatase in pregnancy. II. Serial HSAP65degreesC estimations in pregnancy complicated with hypertension and pre-eclampsia. This is a study of heat-stable alkaline phosphatase (HSAP65degreesC) concentrations in the serum of pregnant women with hypertension (42 cases), mild preeclampsia (40 cases) and severe pre-eclampsia (22 cases). The results are seen in relationship to the occurrence of intrauterine fetal death, growth retardation, intrauterine and neonatal asphyxia as well as the respiratory distress syndrome (RDS) in the newborn. The importance of a precise clinical classification of the patients is stressed. Pathological HSAP values are those which lie either over or under the normal range for HSAP activity. In addition "zig-zag" curves with values within the normal range are characterized as abnormal. Thus, serial estimations give the most reliable results. Serial estimations of HSAP are especially valuable in severe pre-eclampsia. Abnormal HSAP values in the 28th-38th week of pregnancy are a serious prognostic sign. False abnormal HSAP results were found in all 3 patient groups. One possible false normal HSAP curve also occurred.


Studies in diabetic pregnancy. I. Serum lipids. The serum lipid values at different stages of pregnancy in twenty-six pregnany diabetic women attending a special antenatal clinic at the Department of Obstetrics and Gynecology, were compared with the corresponding values in four control series composed of non-diabetic pregnant women. Control series were studied at weeks 10, 22, 34 and after delivery, respectively. Serum triglycerides were higher in the diabetic women at week 10 (p less than 0.01), week 34 (p less than 0.05) and after delivery (p less than 0.05). Furthermore, in the diabetic women, infant birth weights were correlated (r=0.52, p=0.05) with maternal serum triglyceride values at week 31. Women with the highest serum triglyceride values (greater than 250 mg/100 ml) were delivered of infants with a higher birth weight (p less than 0.05) than those women with lower serum triglyceride values (less than 250 mg/100 ml). Intra-uterine deaths (n=4) were not related to maternal serum triglyceride values, but mean blood glucose values (during the whole pregnancy) were higher (p less than 0.001) in mothers with intra-uterine deaths. Elevated plasma free fatty acids (FFA) in the diabetic mother would be a possible cause for elevated serum triglycerides through increased liver triglyceride synthesis, while in the fetus an excess of plasma FFA (passing through the placental barrier) together with normal or elevated plasma insulin would be a likely explanation for increased triglyceride synthesis in adipose tissue and thereby of increased fat depots and body weight.


Inhibitory effect of decidua on fibrinolysis induced by urokinase and by the fibrinolytic activity of the rat ovum. With the use of a technique, which permits the study of fibrinolytic enzymes and inhibitors in organ culture, human decidua was found to produce inhibitors capable of inhibiting plasminogen activation induced by urokinase as well as activators released from kidney explants. Also the medium in which rat and human decidua had been cultured was found to inhibit fibrinolytic activity of the rat ovum. The inhibitors emanating from the decidua are presumably of importance for facilatating the implantation of ova.


A prospective study of drugs and pregnancy. 3. Hormones. Results froma prospective study in Malmö performed in 1963-65 are used to discuss the possible role of hormonal drugs in human fetal maldevelopment. Appr. 2 per cent of all women had a child born were treated with gestagens during early pregnancy and slightly more had used Primodos as a pregnancy test. No harmful effect on embryonic development can be demonstrated.


Phospholipid concentrations in amniotic fluid from diabetic pregnant women. Amniotic fluid phospholipid concentrations measured in 104 samples from 65 diabetic patients have been related to gestational age, tevelopment of the respiratory distress syndrome (RDS). There is statistically significant evidence of accelerated surfactant production in White classes D, F, from 34 to 37 weeks gestation. Classes A, B, C, have phospholipid concentrations not significantly different from a reference series. RDS occurred in 26% and was frequently associated with mature phospholipid concentrations. There was a significant correlation between low Apgar scores and subsequent development of RDS.


Plasma hormone concentrations during the menstrual cycle of normal Chinese women. The concentrations of progesterone, estrogens, luteinizing hormone and follicle stimulating hormone were measured in samples of plasma taken frequently during normal menstrual cycles in fourteen Chinese women. Each of the menstrual cycles was characterized by hormonal changes which were comparable to those previously reported in Caucasian subject.


Effect of a copper and a plastic IUD on the histochemistry of endometrial enzymes in the rabbit during early pseudopregnancy. The influence of a copper and a plastic IUD on the localization and intensity of alkaline and acid phosphatase and beta-glucuronidase activity in the rabbit endometrium during early pseudopregnancy was investigated. The activities of the two lysosomal enzymes, acid phosphatase and beta-glucuronidase were increased in surface epithelial cells in the presence of both types of IUDs. The alkaline phosphatase activity was almost completely abolished in surface and glandular epithelial cells in uterine horns.


Prognosis, recurrences and metastases correlated to histologic cell type in carcinoma of the uterine cervix. An analysis of 230 patients treated with radiotherapy for cervical cancer stages I and II is presented. No positive correlation to cell type was found as regards the number of failures, recurrence rate or the frequency of regional or distant metastases. Although different biological behavior might be shown by cancers of varying cell types, adequate planning and staging before treatment seems to be of better prognostic value.


Value of ultrasonic diagnosis of gynecological tumors in 370 surgical cases. Ultrasonic exploration of the female pelvis to confirm or supplement the usual clinical examination enabled a correct diagnosis to be made in 80% of the 370 cases examined and subsequently operated on. The echographic description always included the size of the tumor, tis cystic or solic nature and its site of origin. Out of 43 uterine and ovarian tumors measuring less than 3 cm, only 15 were discovered.


Prevention of intraperitoneal adhesions by dextran. Hydrocortisone and chymotrypsin. An experimental study. The purpose of an experimental study in guineapigs was to prevent adhesion formation in the intra-abdominal space by simultaneous intraperitoneal infusion of hydrocortisone, dextran and chymotrypsin. An examination made three weeks after the operation revealed a highly significant (p less than 0.001) difference in favour of the dextran, dextran-chymotrypsin and dextran-chymotrypsin-hydrocortisone groups when compared with the NaC1 and control groups.


45,XO Turner's syndrome without evidence of mosaicism in a patient with two pregnancies. A case of Turner's syndrome (45,XO) with two pregnancies is reported. There was no evidence of mosaicism after chromosomal investigation of 5 different tissues (2 ovaries, blood, skin, uterus). Pregnancy occurred in both cases after withdrawal of substitutional hormone therapy. The first pregnancy ended with abortion of a macerated hydrocephalic female fetus. Chromosome studies could not be carried out. The second pregnancy ended with delivery by caesarian section of a normal boy (46,XY). Prenatal chromosome analysis was not carried out for ethical reasons.


The changing panorama of cerebral palsy in Sweden 1954-1970. III. The importance of foetal deprivation of supply. From record data derived from an unselected series of 560 Swedish cases of cerebral palsy, born in 1954-70, the significance of prenatal factors associated with materno-foetal vascular insufficiency causing foetal deprivation of supply (FDS) was investigated. Cerebral palsied children were found to have, on an average, retarded intrauterine growth when compared with a normal population. The incidence of bleeding during pregnancy, maternal toxaemia and multiple pregnancies were significantly increased (p less than 0.001). The incidence of the prenatal factors in question had remained unchanged through the years 1954-70. An additive interplay between factors of FDS and asphyxia/cerebral haemorrhage was revealed. As a whole the findings support the conclusion that FDS plays a major role in the pathogenesis of cerebral palsy today, particularly among the multihandicapped.


Immunological studies in children before and after splenectomy. Fourteen children underwent splenectomy for congenital spherocytosis, splenomegaly, or thrombocytopenia. The patients were studied twice before the operation, three times during the first postoperative month, and one year later. A transitory rise in neutrophils and serum IgA was seen postoperatively; there was a modest but long-lasting increase in lymphocytes and a marked elevation of eosinophils. An immediate decline in serum IgM concentration was observed only in patients with an uncomplicated postoperative course, but one year after splenectomy the average IgM concentration had decreased by 23%. The in vitro lymphocyte transformation response to a panel of mitogens and antigens fell in the immediate postoperative period but was largely normalized 10 days postoperatively, except in the youngest of the patients who had repeated infections following the splenectomy. One year postoperatively the transformation response and the number of T- and B-lymphocytes in the blood were normal.


Hyperosmolality and intraventricular haemorrhage in premature babies. Serial investigations of electrolytes, osmolality and nutritional status were undertaken in 28 babies less than 33 weeks gestation. 6 died with intraventricular haemorrhage, 9 died without intraventricular haemorrhage, and 13 survived. Significant hypersomality was detected in the babies who died with intraventricular haemorrhage, whereas babies who died without intraventricular haemorrhage and survivors had values within normal limits. No relation was found between hyperosmolality and sodium concentrations. Total fluid intake and caloric intake were comparable in the three groups, but protein intake was much reduced in babies with intraventricular haemorrhage due to a lower milk intake. The hyperosmolality could have resulted from tissue breakdown following protein starvation and may be a factor in the occurrence of intraventricular haemorrhage. In premature babies an osmolality of over 320 mOsm/l carried a grave prognostic implication.


The effect of feeding on oxygen consumption, RQ and plasma levels of glucose, FFA, and D-beta-hydroxybutyrate in newborn infants of diabetic mothers and small for gestational age infants. Eight infants of strictly controlled diabetic mothers (IDM), 8 infants of gestational diabetic mothers (IGDM) and 6 small for gestational age infants (SGA) were studied before the first feeding and during an early feeding regimen. In IDMs and IGDMs continuous monitoring from 2 hours up to 7 1/2 hours after birth before feeding revealed no consistent changes of VO2 and RQ. The groups of infants were studied on 4 different occasions: (I) 2 to 16 hours, (II) 1 to 2 days, (III) 3 to 4 days, and (IV) 7 to 11 days. Prefeeding VO2-values were not significantly different between each of the groups, but mean RQ was higher in IGDMs than in IDMs. Age of the infant and prefeeding RQ were inversely correlated (r = -0.537, p less than 0.02). With increasing age and milk intake VO2 increased significantly in all groups. RQ decreased during the first 24 to 48 hours in all groups and rose thereafter with highest values at 7 to 11 days. Plasma levels of glucose, FFA, and D-beta-hydroxybutyrate were not significantly different between each of the group. The highest values for D-beta-hydroxybutyrate were found at 1-2 days when the lowest RQ values were also recorded. D-beta-hydroxybutyrate concentrations and RQ values (r = 0.648, p less than 0.001) were inversely correlated suggesting increasing oxidation of fat. Feeding resulted in a marked rise in RQ to values around unity, which preceded a distinct increase in VO2 that reached a maximum at 1 to 1 1/2 hour after the feed, then slowly returned to pretest values. The rise in VO2 was accompanied by an increase in rectal temperature (0.4 to 1.5 degrees C). VO2, RQ, and plasma levels of glucose, FFA, and D-beta-hydroxybutyrate, were almost identical for each of the groups. We suggest: 1) That differences in feeding practice is the most likely explantation for the discrepancy between reported values for VO2, RQ, and circulating substrates in normal and low birth weight newborns. 2) That the rise in VO2 during the neonatal period, caused by feeding, reflects the cost of growth.


Predictive value of high IgE levels in children. A group of 207 healthy non-atopic children 0-14 years of age without any known family history of atopic disease was selected for a study of the relation between serum IgE levels and the occurrence of atopic manifestations during an observation period of 18 months; 206 fullfilled the study. Serum IgE was measured by a direct radioimmunological sandwich technique (PRIST). At the follow-up 28 of 32 with an initial IgE level greater than one standard deviation above the mean for the age continued to show a high level (87.5%). The total concordance was 81.1%. Atopic or probable atopic diseases had developed in 75.0% of children 0-1 year of age with an initial IgE above +1 S.D., but in only 6.4% of those from the same age group with a lower initial IgE. Even among children 2-14 years old, it was noticement of atopic disease. Otitis media was more frequent among children with an initially elevated IgE level than among the rest of the children. Determination of serum IgE with the PRIST-technique has been shown to provide a valuable means for predicting future atopic manifestations and may be used as a screening procedure especially in children of atopic parents.


Outcome of twin birth. Review of 1,636 children born in twin birth. During the five-year period 1964-68 96 733 births were registered in the 28 hospitals equipped with maternity facilities in the Uppsala hospital region. Of these babies, 1 636 were born in 818 twin deliveries. Data on gestational age, sex, weight and length at birth, birth order, hospital type, congenital malformations and perinatal mortality are analysed. Altogether 17.3 per 1 000 of the children born during this period were born in multiple births. The perinatal mortality for the twin babies was 64 per 1 000 born, with the mortality higher in the less specialized hospitals than the others. Twin no. 1 suffered perinatal death in 67 cases per 1 000 and twin no. 2 in 60 cases per 1 000. For twins of primiparae the losses were 92 per 1 000 children and for twins born to multiparae 51 per 1 000. Altogether 72 per 1 000 male twins died perinatally compared to 52 per 1 000 female twins. The most heavy losses occurred among the low-weight premature twins and in these cases both twins often suffered perinatal death.


Aortic aneurysm developing after umbilical artery catheterization. A variety of complications of umbilical vessel catheterization in the newborn have been reported by earlier investigators. This paper describes a case in which umbilical artery catheterization probably gave rise to an aortic aneurysm. The histological findings suggested that the hypoxic changes in the aortic wall as well as the mechanical effect of the catheter were involved in the origin of the aneurysm.


Umbilical vein catheterization and portal hypertension. Portal hypertension is a rarely encountered late complication of umbilical vein catheterization. A survey of the 38 cases previously published is presented together with an additional case report. It is concluded that catheterization for more than 2 days carries an increased risk of thrombosis, and that umbilical artery catheterization should be preferred in the majority of cases due to a reduced risk of complications. The correct position of the catheter tip must always be controlled by fluoroscopy or X-ray. Infusion of hypertonic solutions with unphysiological pH should be restricted and umbilical vessel catheterization should only be carried out in severe cases. Pretreatment of the catheters with heparin possibly reduces the hazards.


Defective neutrophil chemotaxis and hyperimmunoglobulinemia E-a reversible defect? An eleven-month-old boy is presented with chronic atopic dermatitis and recurrent infections of the skin and respiratory tract, including subcutaneous abscesses. Immunological studies disclosed a neutrophil chemotactic defect, blood eosinophilia and serum hyper IgE. The clinical and analytical data are similar to those of patients previously dermatitis reversed the chemotatic defect, the blood eosinophilia and the clinical symptoms.


Primary hypothyroidism, growth hormone deficiency and congenital malformations in a child with the karyotype 46,XY,del(1)(q25q32). Primary thyroidal hypothyroidism, growth hormone deficiency, congenital malformations and mental retardation occurred in a child with an interstitial deletion of one of the No. 1 chromosomes. Two bands were missing, so that the karyotype could be written: del(1)(pter leads to q25::q32 leads to qter). The possible relationship between the clinical features and chromosomal deletion are discussed.


Pseudomonas cepacia pneumonia in a child with chronic granulomatous disease and selective IgA deficiency. A 6 1/2 year-old boy with chronic granulomatous disease (CGD) and selective IgA deficiency developed a chronic progressive pneumonia which failed to respond to several conventional combinations of antimicrobial therapy. On lung biopsy, Pseudomonas cepacia was obtained in pure culture, sensitive to chloramphenicol, tetracycline, kanamycin and nalidixic acid. With specific therapy, he slowly recovered. P. cepacia has not been previously described as a cause of persistent pneumonia in immunodeficient children. The occurrence of CGD and selective IgA deficiency together is a very rare combination of immunodeficiencies.


Low molecular weight proteinuria and slight hyperlipoproteinemia in three mentally retarded brothers. Mental retardation in combination with proteinuria and a slight hyperlipoproteinemia was found in three brothers. The increased urinary protein excretion was dominated by albumin and the low molecular weight proteins retinol-binding protein (RBP) and beta2-microglobulin, indicating the presence of proximal tubular dysfunction. However, there was no glucosuria, phosphaturia or amino aciduria and the renal concentrating and acidification capacities were normal. A kidney biopsy in one of the patients revealed morphologic evidence of glomerular damage but a normal tubular structure. A mild hyper-beta-lipoproteinemia was found in the patients but not in their healthy siblings. The cause of this syndrome, hitherto not described, is unknown.


[Drinking as a cultural pattern of the Chaco aborigins]. Drinking customs of aborigin groups (mataco-mataguaysos, guaycurúes, and chiriguano-chanés from Chaco) are studied, within the general framework of Phenomenology and phenomenological method. Drinking is considered as a "cultural behaviour"; the research aims at the essence, and therefore the meaning, through the eidos, of this cultural behaviour, and the "being" or Dasein, of the culture to which it pertains. The Lebenswelt of aborigins from Chaco includes three different ways of significance for the symbology of drinking: a) sacral drinking; implying mythical transmutation; b) apocalyptical drinking, implying religious "revelation", and c) annihilating drinking, implying self-destruction. A detailed description is made of the three patterns of drinking in several groups within the tribes studied, and of their symbolic contents and ritualistic operation. At the same time, theoretical approaches of several authors are discussed in relation to the subject, together with analysis of different fields from which the phenomena are studied, including Social Anthropology, Transcultural Psychiatry and Cultural Anthropology, and stressing the difference with current epidemiological approaches that use only epiphenomenological aspects, useful merely for practical assistance purposes, but not for a deep understanding of phenomena.


[Community psychiatry in Latin America]. Present trends of communitary Psychiatry are considered, with an assessment of their measurable parameters and degrees of feasibility. Three models are set forth, taking into account their principal factors: primary mental health agents, actual resources, socio-political structures, geographical setting, cultural patterns, possible strategies, and community participation. Model I is a traditional one, it relies on decisions taken from the administration, which endows both scientific authority and normative power. Participation of the community is not called for, and has neither a place nor a function. The stress is on secondary and tertiary prevention. Model II is more focused on community needs and primary prevention. Programs are conceived after the community is consulted. They use primarily the health efectors within the community itself. Model III stresses active participation of community leaders and members at all levels of decision, and implementation, as well as the use of community's own resources for promoting health. Assistential centers and personnel are only the specialized supports and supervisors of actions, mainly carried out by the protagonists themselves. All three models are analyzed from several standpoints, including theoretical conception, feasbility of implementation, efficacity, vulnerability, cost-benefit ratios and foreseeable outlooks.


[Oedipus tragedy].

[Oedipus tragedy]. Taking into account Paul Ricoeur's theories, two possible hermeneutical positions in front of Oedipus' drama are considered. One is to view it as a fatalistic destiny, bred into the darkest incestuous trends any infant is fighting against, and leading to unavoidable stigmata of everlasting nature. The other is to conceive it as the response to present naked truth, resulting from deep reflexion in order to attain real consciousness of oneself. The former is the "backwards conception", having its own limitations, in its very being buried into the past. The latter, having its projections forward, centers on anguish and anxiety aroused by consciousness of oneself, seeked by the alert responsible mind, able to afford reality and truth with all their thorough implications. The author's existential position embraces the secon conception which had been already exposed by Sophocles in Oedipus in Colonna. The dialectics are set between seeing and knowing. Tiresias is blind, but he can see, because he can afford truth, and its consequence, guilt. Oedipus must fight to attain the possibility of knowing, and must go into the ordeal of losing his eyes, as the only way to reach true self realization, through facing truth and bearing anguish.


Selective intraarterial steroid injection in ulcerative colitis. Angiography was performed in 11 patients with ulcerative colitis and prednisolone injected directly into the superior and inferior mesenteric arteries in 10 patients. Hypervascularity of the affected regions was a common finding, but early venous filling was noted in only 5 cases out of 11. Good results were obtained by intra-arterial steroid injections.


[Marihuana psychoses].

[Marihuana psychoses]. Five chronic consumers of marihuana (through periods of 1 to 3 years) were studied and given a complete set of psychological tests (Rorschach, Wechsler, Phillipson, Psicodiagnóstico Miokinético). Brief case histories and tests results are presented for each subject. In all cases, marked depression, and anxiety, schizoid features, and poor control were detected. In four patients self-aggresion, inversion of sleep cycle, weakness of will and mental confusion were registered. In four subjects a definite psychotic profile was detected through Rorschach tests. Three patients suffered from visual hallucinations, and trends to sexual promiscuity. Memory failure and gaps were apparent in two cases. One patient developed a short-lasting paranoid delusion. Two patients showed no sign of abnormality in their E.E.G. The syndrome shows that marihuana abuse may lead to toxic psychosis similar to schizophrenia. The importance of a systematic use of complete sets of psychological tests is discussed, although their value for a differential diagnosis between toxic marihuana-psychosis and schizophrenia remains to be established. The need for careful search on marihuana abuse is emphasized. Regarding the physiopathology of marihuana-psychosis, some recent findings of neurochemistry are discussed, in particular those of biological theories of schizophrenia. This approach allows a parallel between both disorders. The possibility of both being accounted for by a common metabolic defect is suggested. Finally, the current contention that marihuana is harmless or innocuous is called to revision.


[Programms of community psychiatry].

[Programms of community psychiatry]. Three main resources in all Health Care Programs are classified into three groups: The Psychiatric Hospital. It is a strictly hierarchical organization, where decisions are made at the top of the pyramid, and authority flows down administrative channels. Tasks are clearly defined, and so are responsibilities. The Therapeutic Community. It is a non-hierarchical group, with the goal of re-socializing disturbed individuals. It stresses group and individual responsibilities, aiming at learning new patterns of interaction. All members, patients and personnel alike, are equal members sharing full responsibilities, including decisions concerning the group and/or the individuals. Joining the group, leaving it, or dismissing a member, are all joint decisions. The underlying theory assumes therapeutic potentialities for a group with those special requirements, and for each of its members, regardless of its roles. The Programs of Community Psychiatry. All resources of large population groups are oriented and origanized into comprehensive community programs. All physical facilities are co-ordinated into a network. Personnel is recruited, whenever possible, using the human resources within the same community. All actions, at all scales, are organically co-ordinated in order to maximize benefits and minimize efforts and expenses. All three systems collide substantially, because of their radically different conceptions, grounds and operating requirements. Their many conflicts are analyzed in detail, assessing their consequences on the efficacity of services. A general conclusion is drawn on the valuable data emerging from the application of different systems simultaneously, allowing for future further evaluations. The author stresses that all three systems must be analyzed within a much broader socio-economical framework, and taking into account additional difficulties emerging from: a) great social distance between patient and therapeutic team, impeding exchanges; b) politically unstable climate for officials in charge of mental health policies; c) lack of psychological and technical fitness and heterogeneity of training affecting most mental health workers and agents.


Spinal cord vascularity. III. The spinal cord arteries in man. The arterial supply of the human spinal cord was investigated in detail using microangiography and binocular microscopy after the specimens had been made transparent. (1) The arterial tributaries to the spinal cord were found to come from the anterior radicular arteries in a total number varying from 3 to 15, and from posterior radicular arteries numbering 14 to 25. The location of the great anterior radicular artery varied from Th8 to L3. This artery was most often the only ventral feeder to the lower cord. (2) The surface arteries of the spinal cord were mainly derived from the posterior longitudinal arteries with only tiny anastomoses from the anterior spinal artery. The pial artery plexus was best developed over the posterior surface of the cord, particularly at levels of the enlargements. (3) The intramedullary central part us supplied by the anterior spinal artery and a peripheral part mainly from the posterior longitudinal arteries. Anastomotic connections between the two systems or between individual arteries within the two systems could not be observed.


[Therapy of psychoses in a hospital community]. This study at one Pavilion of Braulio Moyano Hospital allowed an evaluation of the therapeutic community method, applied in a very elastic way due to circumstances like: precarious physical commodities of the pavilion; a typical shortage of everything which became a characteristic of our hospital system; the kind of patients with long evolution psychosis; all this added to the compulsory seclusion of most of them with no friends or relatives relationship established. The pavilion's number of patients is around 110. Statistically, our patients are 67,8% older than 50, with an average age of 56,1 years. Only 19% go out of the hospital with relatives, and 34,8% of them have contact with their families once a week or every 15 days. The most common pathologies are: schizophrenia 54 patients; paraphrenia 20; feeble minded 13; and 9 with reiterative acute polymorphic delusions. Under treatment with neuroleptic drugs we have 94 patients, that is 86%. In occupational rehabilitation they are concerned with monthly luncheon, play entertainment games, go to movies, beauty parlors, ceramics, sewing activities, learning to read and write, and some parties in relevant national dates, all this at the hospital premises. In spite of all these negative facts, we can state that during the period the present study took place, 66% of all the patients released from hospital had been interned less than a year. Besides, between July 1973 and July 1974, 53 patients were released, a figure that shows relevant results for the kind of hospital we are dealing with.


[The psychopathological text].

[The psychopathological text]. Starting from the different epistemological status of looking and hearing in the clinical field, the author stresses the importance of the modalities of approaching the psychopathological text, embodied in its context, and conceived as an intersubjective production rather than an individual phenomenon. The author contends that the psychopathological text can be read in three different ways: 1. Informative. First-hand reading provides cumulative information, conditioned by reader's limitations and imaginary endowment. Likelihood and truth provide its framework, but colliding with each other, being likelihood the first way of organizing perceptual data, whereas truth is to be seeked behind apparent phenomena. 2; Hermeneutical. Reading through interpretation entails deciphering the text according to certain definite rules. The logic of hermeneutics differs from oridinary linear logic in its stemming from joint intersubjective sintactic and semantic recreation. Interpretation provides a joint signification for the discourse, but, because of this very fact, it also makes the codes used to hinge and to create a different universe of signification, and allows for starting the whole process anew. This new universe gives rise to a different link between likelihood and truth, making at least possible, if not necessary, their simultaneous positive values. 3. Maieutical. When the new universes of significations built up by hermeneutical reading are articulated among them, and the system of articulations are set forth, another level is attained, in which meaning is created. Meaning, according to the author's proposal, is generated by the systems of transformations of former universes, both in their synchronic and diachronic processes. Thus, meaning, being open to any possible combinatory of transformations, provides the widest gamut of possibilities to produce sense-and change-in their widest acception.


Complications of orbital and skull base phlebography. Two complications, one in association with frontal vein phlebography and one in association with inferior petrosal sinus phlebography, are presented. Possible mechanisms for complications are discussed. It is concluded that a significant risk exists in association with inferior petrosal sinus phlebography, particularly in association with vascular disorders of the skull base, while the risk in association with orbital phlebography after frontal vein puncture is minimal if compression of the jugular veins is omitted.


Angiographic diagnosis of teleangiectases with cavernous angioma of the posterior fossa. Report of two cases. Two cases of pontine vascular malformation with a characteristic venous angiographic appearance are reported. Both patients had a slowly progressive clinical course, normal spinal fluid, and evidence of a pontine mass. In the late venous phase, large abnormal vessels were seen to coverage towards the midline from each cerebellar hemisphere. The abnormal vessels were microscopically identified as teleangiectases in one of the cases. Both cases had pontine hematomas, originating from a cavernous angioma in one of them; in the other the exact origin of the bleeding could not be determined. It is concluded that in cases with a progressive pontine syndrome the characteristic appearance of the venous phase of angiography may indicate a bleeding pontine vascular malformation.


Objective symmetry detector method for gammaencephalography. VI. Comparison with subjective evaluation of brain scintigraphy. The diagnostic accuracy of brain scintigraphy and the objective symmetry detector method for gamma encephalography is compared. The objective symmetry detector method was found more efficient in separating brain tumour patients from normal than a group of ten radiologists interpreting brain scintigrams.


Repeat scintigraphy of the internal mammary lymph nodes in rabbits. Rabbits were subjected to different combinations of scintigraphy of the internal mammary lymph nodes, fractionated irradiation, and surgical trauma to the chest wall. No influence could be demonstrated on the image at repeat scintigraphy of the internal mammary nodes. Microscopic changes in the lymph nodes and vessels were relatively slight and inconstant.


Pharmacoangiography in experimental tumours. Evaluation of vasoactive drugs. Pharmacoangiography with four vasoactive drugs was performed in experimental renal and hepatic tumours in rats in order to compare their ability to demonstrate tumour vascularity. Three vasoconstrictors, angiotensin, norepinephrine and vasopressin, and one vasodilator, tolazoline, were tested, vasoconstrictors giving most diagnostic information and the difference in effect among these sometimes being small and probably dose-related. This diagnostic effect is based upon the primitive character of tumour vessels, being unable to react upon a vasoactive stimulus. Angiotensin turned out to be the superior drug which corresponds to clinical experiences of this drug.


Angiography in malignant and chronic inflammatory lesions of the gallbladder. Angiography findings in 18 patients with carcinoma of the gallbladder and 17 with cholecystitis indicate that similar abnormalities may appear in both lesions. Irregularities and obstruction of arteries were more common in malignant disease and somewhat more severe. Accumulation of contrast medium and prominent veins occurred in both groups. Displacement of adjacent vessels was more common in malignant  disease. As chronic inflammatory lesions cannot with certainty be differentiated angiographically from malignant disease, cholecystectomy is recommended when the abnormalities described are demonstrated.


Experimental evaluation of tube potential and contrast medium concentration for cholangiography. Model cholangiographic experiments were performed in which the relationship between contrast medium concentration, duct diameter, calculus size and tube potential was analysed. The same degree of diagnostic reliability was obtained by increasing the tube potential as by diluting the contrast medium. A tube potential of 100 to 110 kV and a contrast medium concentration of 45 per cent were found to give the best result if the background density of the film was held constant.


Videodensitometry in the diagnosis of aortic incompetence. The videodensitometer has been used in a group of 20 patients with aortic incompetence and incompetence combined with stenosis. The method appears effective in the preoperative evaluation of the valvular and ventricular function of the patient. It gives objective and probably more accurate information of the regurgitation fraction and the ejection fraction than the commonly used semiquantitative methods. The method is simple to use and needs no technical changes in the roentgen equipment.


Kinematic analysis of posterior spinal fusions in pigs. Five pigs operated upon by posterior spinal fusion were examined by a roentgen stereophotogrammetric method during provoked motion. The healing process leading to marked rigidity within the spine was followed in two of the pigs. Varying degrees of stability in the fused area were achieved in the five animals. Movements were detected, not only when the fusions were not healed, but also in two cases of incomplete bony union between two operated segments.


Metastasis from an unknown tumour.

Metastasis from an unknown tumour. A total of 121 patients were treated under the diagnosis: metastasis from an unknown primary tumour; 99 were irradiated. In 46 cases the primary tumour was detected from 6 months to 10 years after the primary treatment. The 3-year survival was 28.9 per cent, the 5-year 17.4 per cent and for 10 years or longer (up to 14 years) 9.1 per cent, after the primary treatment. The prognosis is correlated to the size of the metastases, their site and also their microscopic appearances.


En-bloc irradiation of tumours of the head and neck and their lymphatics. I. Technique and dosimetry. A technique for en-bloc irradiation of tumours of the head and neck and their lymphatics, as well as its dosimetry and control measures, are reported.


Effect of lung irradiation on the incidence of pulmonary metastases and its mechanism. LP-12 cells injected intravenously into ddY mice result in the formation of visible lung colonies which are introduced as a model for pulmonary metastases. Localized irradiation before tumour cell transplantation significantly increased the incidence of pulmonary metastases in the irradiated lung only. The changes of the vascular permeability of the lung indicate that dilatation of capillaries or increased permeability may be one of the main mechanisms of this phenomenon.


Skin reaction as a biologic parameter for control of different dose schedules and gap correction. In patients with mammary carcinoma, irradiated postoperatively on the parasternal regions, prospective dose calculations for different fractionation schedules have been performed with the CRE formula. The biologic radiation effect on normal tissue was recorded by reflectance spectrophotometry of skin erythema and pigmentation. The right side received 4 050 R in 25 days, the left side 4 390 R in 47 days with a gap of 3 weeks. A compensation for the gap with 8 per cent of the total exposure was found to be adequate. The smallest exposure difference that could be clearly discriminated visually and with spectrophotometry was recorded in a special series and was found to be 6 to 7 per cent.


Radiation sensitivity of lymphocytes from human blood and from the thoracic duct. Peripheral blood and thoracic duct lymphocytes are sensitive to irradiation. However, a distinct population of resistant lymphocytes exists, which is characterized by reactivity to a very low dose of lymphocyte-stimulating lectins in vitro. Blood lymphocytes are rapidly eliminated from the circulation after radiation damage. An analysis of the function of blood lymphocytes is thus of little or no use in assessing the therapeutic effect of extracorporeal irradiation. Lymphocyte activation must accordingly also be unsuitable for use as a biologic dosimeter after accidental total body irradiation.


Measurements of single event spectra with a wall-less proportional counter in low LET radiation fields. Measurements have been made on 60Co gamma rays from a point source and on 6 MV roentgen rays from a linear accelerator with a wall-less proportional counter. Single event spectra have been measured in sites of 0.5-2 mum in diameters stimulated with a tissue equivalent gas. Calculations of the relative variance in LET are performed and compared with the relative variance of the measured distributions for estimates about the straggling contribution.


Right atrial monophasic action potential in healthy males. Studies during spontaneous sinus rhythm and atrial pacing. Right atrial monophasic action potentials (MAP) have been recorded in 40 healthy males. At least one MAP recording was performed in each individual during spontaneous sinus rhythm. Right atrial pacing and simultaneous MAP recording were performed in 25 of the 40 individuals. The paced cycle length was successively decreased in steps of 100 msec between 800 and 400 msec. The durations of the MAP at 50 and 90% repolarization and the relative repolarization rate during phase 3 (RRR ph 3) were calculated and normal values for the variables are given. A correlation was demonstrated between the duration of the MAP and the cycle length-the longer the cycle length, the longer the duration of the MAP-both during sinus rhythm and during the atrial pacing. A significant correlation was also shown between the RRR ph 3 and the duration of the MAP at 90% repolarization-the shorter the MAP, the faster the RRR ph 3. One age group (45-54 years) deviated significantly from the rest in some respects, but in general there was no age trend in the whole material.


Atrial repolarization in healthy males. Studies with programmed stimulation and monophasic action potential recordings. Right atrial effective refractory periods (AERP) and monophasic action potentials (MAP) have been determined in 29 healthy males in four different age groups between 25 and 64 years. One age group (45-54 years) showed a significantly longer AERP than the others, with a mean of 283 msec compared with 230-238 msec in the other groups. However, no age trend was found in the total material. The AERP decreased at higher paced heart rates, the decrease between paced cycle lengths of 800 and 600 msec amounting to 13 msec. When the MAP and the AERP were determined in the same position of the atrium, they showed no statistically significant correlation. A possible explanation is that the cells contributing to the AERP and the MAP are not altogether the same. The MAP and the AERP determinations have a similar degree of reproducibility but possibly mirror different kinds of repolarization phenomenon.


Determination of pressure gradient in mitral stenosis with a non-invasive ultrasound Doppler technique. A 2 MHz continuous waveform non-invasive ultrasound doppler system has been used in the present investigation. With the aid of the audio signals of the frequency shifts, the ultrasound probe was positioned on the external chest so that the axis of the incident ultrasonic beam coincided with the direction of the maximum velocity vectors of the mitral jet. The frequency shifts due to the mitral jet were frequency analyzed and the time course of the maximum frequency shift was determined. The time course of the maximum mitral jet velocity was then determined from the doppler equation and the time course of the mitral pressure gradient from an orifice equation. The usefulness of the technique was evaluated by studying 25 patients with mitral stenosis and 10 without heart disease. The patients with mitral stenosis were studied during cardiac catheterization and the ultrasound data, the pulmonary artery wedge pressure, and the left ventricular pressure were recorded simultaneously. A table is presented where the gradient determined with the ultrasound technique, deltaPU, is compared with the gradient determined from the pressure tracing, deltaPM. Averaged over the 25 patients studied, deltaPU was 1.7 mmHg smaller than deltaPM at 0.08 sec diastolic time and 1.8 mmHg smaller at 0.25 sec diastolic time. The findings in the patients without heart disease differed distinctly from those in the patients with mitral stenosis. The investigation demonstrated that the non-invasive ultrasound technique can be used with confidence to gain an impression of the magnitude of the mitral pressure gradient. The findings also suggest that deltaPU represents the actual pressure gradient more accurately than deltaPM. Another investigation is proposed to assess the accuracy of the technique more completely.


Significance of cardiac arrhythmias preceding first cardiac arrest in patients with acute myocardial infarction. In 417 consecutive cases of acute myocardial infarction (AMI) within a minimum of 21 days' stay in the Coronary Care Unit (CCU), primary cardiac arrest occurred in 41 patients (9.9%), the first episode occurring during ECG monitoring in 24 patients. After cessation of ECG monitoring, and within 2-25 days after admission, it occurred in 17 patients. Cardiac arrhythmias before the first cardiac arrest were analysed in these two groups of patients, and compared with the occurrence of cardiac arrhythmias within the first 5 days in 100 consecutive patients with AMI without complicating cardiac arrest. No significant difference in the frequency of cardiac arrhythmias could be demonstrated between the two groups with cardiac arrest and the control series. Moreover, complete absence of rhythm disturbances right up to the beginning of cardiac arrest was as frequent in the patient groups as in the control series (around 20%). As there is not sufficient evidence that treatment with antiarrhythmic drugs can provide safe prophylaxis against the occurrence of cardiac arrest, it is concluded that all patients with AMI should be kept in the CCU and monitored, by cable or by telemetry, for the duration of their stay. To achieve this, the cost in financial terms, manpower and reorganization is not a deterrent. Furthermore, this study does not give any support to the usual practice of confining possible attempts of prophylactic antiarrhythmic treatment to patients with arrhythmias of certain frequencies and/or types.


The sick sinus syndrome.

The sick sinus syndrome. Clinical and electrophysiological characteristics have been investigated in a group of 30 patients with a sick sinus syndrome. No predictable response to exercise or drugs was observed, although a poor response of the sinus rate to atropine was present. Distal conduction abnormalities were found in seven of 14 patients, in whom detailed electrophysiological measurements were made, and sinus node recovery time was abnormal in all except one. Treatment with permanent pacing not only relieved syncope and dizziness, but made drug treatment of associated tachyarrhythmias feasible. The elusive and intermittent nature of the syndrome is stressed. The pathological findings in one case are described at length.


Platelet adhesiveness in myocardial infarction in relation to clinical course. ADP-induced and whole blood platelet adhesiveness have been studied by repeated measurements during the acute stage of the disease and the following two months in 86 randomly selected patients admitted to a coronary care unit because of acute central chest pain. In the patients who developed ECG and enzyme changes typical of infarction (group 1), platelet adhesiveness was significantly increased on admission compared with the rest of the patients (group 2) and controls (group 3). Patients in groups 1 and 2 showed a secondary increase during the first week, but two months after admission the means had returned to values within the normal range. No correlation was found between platelet adhesiveness and infarction size or fatal outcome of the disease. Platelet adhesiveness did not differ between patients with ECG changes indicating a transmural infarct and those with mainly subendocardial infarction.


Renal stones and coronary heart disease. The relationship between risk factors for coronary heart disease (CHD) and renal stone disease has been studied in a population of more than 2000 middle-aged men. The only positive association found was a slight increase in diastolic BP among stone formers and a higher stone prevalence in untreated hypertensives. Furthermore, the prevalence of a history of renal stones in male survivors of myocardial infarction (MI) was similar to that found in the population study. An investigation of the vitamin D intake by means of a dietary questionnaire revealed no differences between stone formers, healthy controls and MI survivors. Contrary to other reports, the present study indicates that the risk factor profile for CHD in stone formers is similar to that in the general population.


Maximal bioavailability of digoxin from tablets and oral solution in steady state. Comparison has been made between the absorption of digoxin from Lanoxin tablets and the absorption of international chemical reference substance digoxin from an oral solution. Plasma levels, areas under 24-hour plasma concentration curves and urinary excretion were similar by both formulations in steady state. 78% of the digoxin administered was absorbed from the tablets and 76% from the solution. Rapid dissolution in the intestinal fluids accounts for the high digoxin bioavailability of the tablets.


Antihypertensive effect and side-effects of bendroflumethiazide and propranolol. The antihypertensive effect and side-effects during 12 months' treatment with bendroflumethiazide and propranolol have been compared in two randomly selected, equally large groups (n= 53) of previously untreated male hypertensives. Systolic BP above 170 or diastolic BP above 105 mmHg on two occasions were defined as hypertension. The same BP reduction was achieved in both groups. During the 12 months' treatment one subject on bendroflumethiazide developed diabetes mellitus and one on propranolol developed cardiac decompensation. None developed gout. Contrary to what had been presumed, glucose tolerance improved during 12 months' treatment with both agents, while there were no changes in fasting blood sugar, insulin or triglyceride concentrations. No changes were found in serum potassium or total body potassium during 12 months' bendroflumethiazide treatment, while serum potassium increased during treatment with propranolol. Uric acid increased slightly during treatment with both agents. Prolongation of the follow-up to 24 months did not change any of the findings regarding metabolic changes during treatment. The frequency of subjective side-effects decreased to the same extent during treatment with both drugs. It is concluded that bendroflumethiazide and propranolol are equally useful as antihypertensive agents and that the risk of impariment of glucose metabolism and potassium balance seems to be very slight during treatment with bendroflumethiazide in mild hypertension.


Is the use of hypnotics, sedatives and minor tranquilizers really a major health problem? An analysis has been made of individual purchases of hypnotics, sedatives and minor tranquilizers made during 1973 by patients who had bought such drugs either only once (group S, n= 417) or regularly (group R, n=76) during a 16-month period five years earlier from pharmacies in the town of Ostersund, county of Jmtland, Sweden. By 1973, 17% of the patients in each group had either died or moved out of the country and were therefore excluded from the comparison. In group S, 81 patients (23%) bought the above drugs once or more in 1973, while the corresponding figure for group R was 55 (87%). Compared with 1968-69, there was a decrease in the number of prescriptions and also in the number of tablets obtained per individual. Furthermore, the number of tablets per prescription was lower in 1973. Among the drugs prescribed, benzodiazepines dominated during both periods, followed by barbiturates. In 1973 there was a substantial increase in the use of nitrazepam, mostly at the expense of diazepam and combined products. One patient in group S and one in group R showed a tendency to decrease the interval between purchases. The latter was already known to be a drug abuser five years earlier. Without knowing the reason why the drugs were prescribed and to what extent they were actually taken, it is impossible to say whether the other patient should be classified as drug abuser or not. Although the number of patients in this study is limited, it might be concluded that the risk of an occasional user of hypnotics, sedatives and minor tranquilizers living in this area becoming an abuser of such drugs within a five-year period is less than 1/345.


Interferon therapy in Hodgkin's disease. A case report. The treatment of a case of Hodgkin's disease (lymphocyte predominance, stage IV B) with exogenous i.m. interferon therapy is described. B symptoms disappeared, diseased nodes and pulmonary infiltrations decreased in size, and laboratory values normalized. Clinical improvement was associated with increased mitogenic responsiveness of the patient's lymphocytes towards various stimuli in vitro. After almost half a year's treatment tumour progression and a decreased mitogenic response were again observed. Interferon treatment was then abandoned and combined cytostatic courses were instituted. Partial remission was achieved after 6 months of cytostatic therapy, i.e. 1 year after the start of treatment.


Sheehan's syndrome of hypothalamic origin in a woman with juvenile diabetes mellitus. A 25-year-old woman with severe diabetes mellitus since the age of 7 developed anterior pituitary insufficiency after pregnancy toxaemia with hypofunction of the thyroid, ovaries and adrenal cortex. Following the development of Sheehan's syndrome, her insulin requirment decreased dramatically. I.v. administration of TRH, LRH and vasopressin induced nearly normal pituitary response levels of TSH, LH and plasma cortisol, indicating a hypothalamic damage as the primary aetiological factor.


Acute myeloma.

Acute myeloma. This patient had an acute onset of myeloma, with hypercalcemia, a high M-component in the plasma, Bence Jones proteinuria, and 37% plasma cells in the bone marrow sample. After melphalan treatment (210 mg totally) he seems to have a complete cure, with total disappearance of the M-component, Bence Jones proteinuria, myeloma cells, hypercalcemia and elevated ESR for almost three years.


[Pathogenicity test for staphylococci by the use of adrenaline (author's transl)]. Pathogenic staphylococci will grow in broth containing 50 mug/ml adrenaline at 37 degrees C, while apathogenic ones tolerate a concentration of 20 mug/ml only. They are completely inhibited at higher adrenaline levels. After 6 hr incubation, pathogenic germs show growth up to 100-250 mug/ml adrenaline, apathogenic ones up to 40 mug/ml.


The macroconidial septum of some dermatophyton species. The septum of the macroconidium (MC) of dermatophytes was examined by light microscopy. Significant taxonomical differences between species have not been found. The septa seem to be three-layered, but only the middle layer can be considered a septum in the wall substance of two neighbouring chambers, impressed and completed by the septum. The septum verum originates from the middle layer of the three-layered MC wall or from its surface adjacent to the chamber wall. This type of septum is different from that described in Ascomycetes and other species. Light microscopic findings are insufficient to characterize the nature of the septal pore. The microscopic observation of the layers of the MC wall and of the septum may be disturbed by misleading optical phenomena.


Effect of ts mutation in gene 43 of bacteriophage T4 on recombination of the bacteriophage. Certain ts mutations in gene 43 of bacteriophage T4 are known to exhibit mutator or antimutator activities with respect to different rII mutations of this phage. The effect of these mutations on recombination frequencies of double mutant strains of phage T4 with genotype rII ts--homoallelic with respect to the ts trait--was examined. The results implicate the essential role of the genetic background in the investigated process.


Respiratory activity of the soil from several habitats in the Botanical Garden in Poznań. The paper presents studies on the respiratory activity of the soil from two habitats of the Botanical Garden: the steppe and the dune. The abundance of bacteria and fungi in the soils was also estimated. Respiration in the rhizosphere soil was found to be more intense than in the non-rhizosphere soil. Our observations have shown that soil respiration depends largely on the abundance of microorganisms. Under various habitat conditions, however, the microorganisms populations are characterized by some peculiarities of their metabolic activities. These manifest themselves in differences in respiratory activity of various soils independent of additional easily available energetic material introduced into the soil.


Polygalacturonase activity of Penicillum sp 7/4B/EI 1 mutant grown on some by-products of food industry. Pectolytic activity of the Penicillum sp 7/4B/E11 mutant, which synthesized effectively PG and was not capable of producing PE, was studied on some by-products of food industries (apple pulp, beet pulp, and mixtures of apple pulp or beet pulp with wheat bran) supplemented in some experiments with mineral salts of the Czapek's medium. The strain showed good growth but a low PG activity when grown on by-products without mineral salts and an increase in PG activity after cultivation on these by-products (mainly on beet pulp) enriched with mineral salts. The highest PG activity was obtained after 6-8 days cultivation on beet pulp (3%) with mineral salts. Among the tested salts, NaNO3 influenced PG activity most effectively, K2HPO4 and MgSO4 to a smaller degree whereas others were ineffective. The mutant did not synthesize PE under these culture conditions.


Influence of the concentration of phosphorus, potassium, calcium and iron compounds on the microbial reduction of sulphates. In the reduction process of sulphates by Desulfovibrio desulfuricans suitable concentration of mineral salts plays an important role. In particular, different K2HPO4, CaCl2 and Fe(NH4)2(SO4)2 content in the reaction medium has an observable effect on the reduction degree (x'), the induction time (t0) and the reduction rate constant (k). These data were recorded for 9 liquid media characterized by different content of mineral salts. The reaction rate constants were calculated for the reduction process in each medium. Optimal reduction conditions exists at the following element concentration ratios: P/S=0.068, K/S=0.086, Fe/S=0.08, N/S=0.33, C/S=1.80, Ca/S=0.03, Cl/S=0.80.


The utility of self-management procedures in modifying the classroom behaviors of mentally retarded adolescents. Self-management procedures including the self-recording of points, the self-graphing of progress, and the self-selecting of free time activities were applied to the classroom behaviors of 12-year-old educable mentally retarded subjects. Students were first awarded points for specified appropriate behaviors. Then during the last two treatment phases, they graphed their points earnings and used these points to earn free time activities. A multiple baseline design was used in appraising the comparative effects of these three treatment conditions during spelling and reading periods. All three treatment conditions produced higher rates of appropriate behavior than did baseline conditions; however, the highest levels of appropriate behavior were achieved during the self-selected free time phases.


alpha-L-Fucosidase in normal and deficient individuals. Deficiency of the enzyme alpha-L-fucosidase has been demonstrated in peripheral leukocytes, cultured skin fibroblasts and long-term lymphoid lines from two sibs with fucosidosis 2. Reliable identification of heterozygotes for this disease was accomplished by enzyme assay of mononuclear cells isolated from peripheral blood. Isoelectric focusing of alpha-L-fucosidase isozymes in leukocyte extracts from normal individuals revealed a common polymorphism which was shown to result from two autosomal alleles at a single, autosomal locus. Evidence was obtained for a third, "silent" allele segregating in the family of the two affected children. It is probable that the disease fucosidosis type 2 results from homozygosity for this "silent" allele. Preliminary experiments have shown that cultured skin fibroblasts from deficient individuals can incorporate and retain purified alpha-L-fucosidase added to the culture medium.


Polyunsaturated fatty acid lipidosis: a new nosological entity. Lipid analyses in the terminal stage of the disease polyunsaturated fatty acid lipidosis (PFAL), showed a brain very poor in lipids. The concentration of sphingolipids was particularly low: gangliosides of cerebral cortex was only 10% of the control value, and cerebrosides of white matter only 2%. Of the gangliosides, GM1 and GD1 a were reduced more than any other ganglioside fraction. The fatty acid compositions of the phosphoglycerides were the same in cerebral cortex and white matter. Compared with what was found in the controls, ethanolamine phosphoglycerides had much higher proportions of  18:1 and 20:4 (n-6) and much lower proportions of 22:4 (n-6) and 22:6 (n-6) and 22:6 (n-3) in the cerebral cortex. Similar changes in the fatty acid patterns were found in the other phosphoglycerides. It is assumed that in PFAL there is a primary disturbance in the metabolism of arachidonic acid, which leads to a series of secondary changes. The results suggested that the gangliosides GM1 and GD1a, sialidase and phosphoglycerides with dokosahexaenoic acid are confined to the nerve endings.


Ultrastructure and biochemical studies of rat CNS and viscera after subcutaneous injection of chlorphentermine. Ultrastructural and biochemical studies were carried out on three groups of experimental models which were induced by a single subcutaneous daily dose of 10 to 40 mg./kg. body weight of chlorphentermine hydrochloride. The first group consisted of 20 young adult rats which were sacrificed at intervals of from one to four weeks. The liver and lungs showed concentrically arranged memberanous bodies in the hepatocytes and alveolar cells during the first week after the first injection, while the CNS and pancreas showed no ultrastructural alterations. During the fourth week, the pancreas displayed abnormal cytoplasmic inclusion bodies in the A and B cells of the islets of Langerhans as well as in the exocrine portion. The brain showed various neuronal alterations at four weeks which consisted of irregular dense bodies to well-developed membranous structures which were similar to those of Tay-Sachs disease. Biochemically, thin layer chromatograms showed that the major ganglioside fraction in the brain at four weeks had an RF value similar to that of GM1-ganglioside. In an analysis of the total N-acetyl neuraminic acid the brains in the experimental group contained 90.9% GM1-gandlioside as compared with 44% in the controls. The total and fractions of phospholipids in the brains and livers of the experimental animals were within normal limits.