[Further cases of Ehlers-Danlos syndrome of the renovascular dysplasic variety]. One hundred and twenty patients with arterial hypertension and 3 cases of fibromuscular displasia of the renal arteries (FDRA) (group D) were studied; besides the usual arterial hypertension work up, a search of Ehlers-Danlos syndrome stigmata was carried out in all patients. The population of 120 hypertensive patients were classified in 3 groups: group A, fromed by 104 subjects without EDS stigmata; group B, constitued by 7 cases with hypermobility of one to three metar-carpophalangic joints and group C in which 9 subjects with hipermobility of more than 3 metacarpophalangic joints were included. Neither case of groups A and B showed arteriographic signs of FDRA. In 4 cases of group C there were arteriographic evidence of FDRA (3.3% of the whole population) and stigmata of SED (2 cases with skin biopsy positive for this entity). Two cases of group D showed stigmata of SED and a positive skin biopsy; the other case had a normal histology of skin and no clinical signs of SED. The presence of SED stigmata in a patient with arterial hypertension should alert the clinician in the diagnosis of FRDA; in such a case it is recommended that a renal arteriography be performed. In this paper similarities of SED of the arterial type and some cases of FDRA are remarked and it is proposed the both entities share the same or a very closed molecular collagen defect.


[Trans and postoperative myocardial infarct in heart surgery]. 1. A study was made of 34 cases (33%) of myocardial infarction trans and immediately postoperative which occurred in 11,210 surgical interventions with and without extracorporeal circulation. 2. This presents a statistical relation of the frequency of myocardial infarction in realtion to the heart disease acquired with or without extracorporeal circulation with the mitral, aortic, and double prosthesis of the mitral and aortic valves. A correlation was also made with the ischemic heart disease subjected to revascularization. The same analysis was carried out in the congenital heart disease with or without extracorporeal circulation. 3. In all cases the antecedents, precipitating factors, and the clinical picture were studied and in 12 cases the necropsy was analized. The principal finding was transmural myocardial infarction with electrocardiographic proof and serial enzymes. 4. The group was divided into two sub-groups; Group "A" with acute myocardial infarction transoperative, and Group "B" with acute myocardial infarction in the first eight postoperative days. The electrical and mechanical complications were analized. 5. A correlation was made of the causes of mortality related to the type of congenital or acquired heart disease with or without extracorporeal circulation. 6. The frequency of this entity was studied with the total time of aortic clamping, and the complications such as the low cardiac output syndrome, rupture of the wall, aneurysms, acute pulmonary edema, and with the disturbances of rhythm and conduction. 7. The presence of 33.3% of normal coronaries in these of necropsy was emphasized. 8. The importance of the coronary profile of this group in relation to the consequences of a stress from anesthesia, surgery, extracorporeal circulation, and aortic clamping is mentioned. 9. The diagnostic parameters such as arterial hypotension with or without the low cardiac output syndrome, enzyme levels, and the action of the potassium ion are mentioned. 10. An analysis is made of the possible etiological factors of the precipitation of the myocardial necrosis in the cases with normal coronaries and those in which there was no important obstruction of the coronary macrocirculation. 11. In the subgroup "A" it was found that the frequency of myocardial infarction was less than in the subgroup "B", but there was greater mortality in group "A". The possible causal factors are analized.


[Factors influenceing the activity of oral anticoagulants]. Anticoagulants are drugs capable to retard or even cancell the process of blood coagulation. They are many factors who influences the intensity and duration of oral anticoagulant acitivity, such as drugs, body constitution, physical agents, diseases, etc. The oral anticoagulants interacts with other drugs at differents levels: at the gut, at the plasma, modiffing the protein binding or the metabolism of such drugs, at the enzimatic induction or inhibition, or at unknown places with many other drugs. These paper deals with the description of such interactions.


Left anterior fascicular block concealing anteroseptal infarction. Fascicular blocks may modify electro-cardiographic morphologies and signs of necrosis may be masked. This report concerns the case of a patient with an anteroseptal myocardial infarction who developed a transient left anterior fascicular block. An explanation for the concealment of the signs of necrosis is proposed, based on an analysis of the modified activation process by means of a vectorial representation.


[Aneurysm of the membranous portion of the interventricular septum]. The membranous portion of the interventricular septum represents the final phase of the ventricular growth. It is situated between the orifice of the coronary sinus and the supraventricular crest; immediately below the right aortic semilunar valves and not the coronary. Four cases of aneurism of the membranous portion of the interventricular septum are presented; in two, the diagnosis was made by angiocardiography study and in the rest it was made with the findings of an autopsy. All were of the female sex. Two patients presented a systolic murmur in the low mesocardia; three had heart failure, two of which were secondary to an arteriovenous short circuit through an interventricular communication, and the other due to alternations in the automatism and in the atrioventricular circulation. One case had W-P-W, type A and during its evolution presented paroxysms of atrial fibrillation and flutter, variable degrees of atrioventricular block with Stokes-Adams syndrome and ventricular fibrillation. In one case an obstruction at the level of the outflow tract of the right ventricle was suspected through phonocardiographic studies, and was confirmed subsequently with hemodynamic study. This same case presented a protosystolic aortic snap, at 0.13-0.14 sec. of the q wave of the electrocardiogram, described as of value for the diagnosis of this malformation. In two cases the angiocardiographic study showed the presence of the aneurism in the membranous portion of the interventricular septum, in one, it was visualized in the posterioanterior projection and in another in the lateral. One of the specimens had the aneurism adhered to the tricuspid septal valve, and also a fissure which communicated the left ventricle with the right atrium. In the other, the aneurismal sac was located below the septal valve of the tricuspid, producing a distortion in the anatomical architecture of the atrioventricular orifice.


[Intermediate syndrome: electrocardiographic, angiographic and clinical characteristics and their development under medical treatment]. An emphasis is placed on the definition and separation of the acute coronary insufficiency from the other "status anginosus", because the natural history and its physiopathology is of a distinct nature and actually still not very precise. A group of 19 patients was studied which filled all the clinical, electrocardiographic and enzymatic requisites of the genuine acute coronary insufficiency. Among these a subgroup of 13 patients was found with the classic Prinzmetal syndrome. In all cases the following were studied: antecedents, risk and coronary profile, the pain syndrome, electrocardiographic alterations, enzymatic modifications, coronariographic findings modifications, coronariographic findings and the ventricular function through ventriculography. The frequent occurance in the female sex is pointed out as well as the importance of the social and sensorial stress. We effected and described the correlation between the number and intensity of the pain crises and coronariographic findings. The electrocardiographic and coronariographic findings were correlated in the Prizmetal variety as well as in the entire group. An analysis was made of the correlation between the number and degree of coronary obstructions and the areas of ventricular diskinesia. The apparent paradox between an important number of cases with ventricular diskinesia and the limited number of cases with clinical and radiological left ventricular failure was mentioned and discussed. An analysis is made of the theoretic models of the ischemic heart disease in relation to the coronary macro and microcirculation and the possible influence of the catecolamines and the collateral circulation. The different physiopathological mechanisms introduced in this entity whose genuine world wide ocurrence is not very elevated. The evolution and morbi-mortality of those cases placed under medical care is analyzed.


[The bradycardia-tachycardia syndrome].

[The bradycardia-tachycardia syndrome]. Disorders of the heart rhythm which consist basically of sinus bradicardia or sinus arrest correspond to a syndrome which has been named the sick sinus syndrome. Within the framework of this syndrome, there is a subgroup of alternating atrial bradycardia with episodes of atrial tachyarrhythmia. Generally known as the bradycardia-tachycardia syndrome, this subgroup is both electrophysiologically interesting and therapeutically challenging. This report is concerned with the experience obtained at the emergency ward and coronary care unit of the Instituto Nacional de Cardiología de México on the diagnosis and management of 8 patients with this syndrome. Various underlying heart conditions were present with predominance of ischemic heart disease. The clinical picture was dependent upon the hypoperfusion of vital organs secondary to the cardial arrhythmia. The most common symptoms were derived from cerebral circulatory deficit and coronary insufficiency. Half of the patients had moderate cardiac failure. All patients had spontaneous and transient loss of sinus function which lasted more than 2,000 msec. in seven. The bradycardia had a rate below 50 beats per minute in all cases except one. The tachyarrhythmias observed were atrial flutter, atrial fibrillation and paroxysmal supraventricular tachycardia. Three of the patients had more than one of these these tachyarrhythmias during the period of study. A discussion is made on the diagnosis of this syndrome by means of atrial pacing and interventions which modify either vagal or sympathetic tone. Considerations are also made on the frequent associated abnormality of the A-V functional tissues. Emphasis is placed on the problems encountered in the management of these patients. It is concluded that, in most cases, a satisfactory result may be obtained by the implantation of a permanent demand pacemaker associated to the administration of antiarrhythmic drugs.


Folic acid binding protein and folate balance in uremia. To determine the incidence and importance of folate deficiency in uremia, we studied 41 patients who had chronic uremia but who were not receiving hemodialysis. Serum folate level was assayed by microbiological, whole serum radioassay, and heat-extracted radioassay techniques. Mean serum folate level, as determined with the Lactobacillus casei method, was 6.9 ng/ml (normal, more than 3.0 ng/ml). The mean heat-extracted radioassay serum folate level was 6.6 ng/ml. Only 10% of our patients had subnormal serum folate values, as determined with these techniques. No cases of megaloblastic anemia were discovered, and the hematologic profiles correlated with L casei and heat-extracted radioassay serum folate values. The mean serum folic acid binding protein (FABP) level was significantly greater for the uremic patients than for control patients (26% vs 9.9%, respectively; P = .0005). Our results show that elevated levels of serum FABP spuriously depress the serum folate level, as determined with the whole serum radioassay technique, but apparently do not retard delivery of folate to the tissue in vivo.


[Single ventricle. New embryological-anatomical classification. I. Pathology and physiology]. The different nomenclatures which have been given to this malformation are discussed, defining the single ventrical as a single ventricular chamber without an interventricular septum and generally with two well defined atrioventricular orfices, although in some cases there is only one mitral-tricuspid ring. Twelve cases of single ventricle, proven by necropsic study, were examined. A new embriological-anatomical classification was proposed based on the location of the outflow tract (concordant or discordant in relation to the situs viscerae of which it is a part) and the troncoconal morphology (crossed great vessels, transposition of the great arteries, and truncus arteriosus), presenting some examples of these malformations. The pathological characteristics of the malformation in each of the established groups is described, as well as the physiopathology in the most frequent varieties. The defects associated with single ventricle are studied.


[The renin-angiotensin-aldosterone system in the diagnosis of renovascular arterial hypertension]. Twenty one subjects with sistemic arterial hypertension and arteriographic signs of obstructive lesion of the renal artery were studied and classified in 3 groups: group A, 13 cases with bilateral renovascular lesions; group B, 4 patients with unilateral renovascular stenosis and group C, formed by 4 subjects with a segmental branch stenosis of a renal artery. In all cases an special protocol was followed to measure plasma renin activity (PRA) in blood taken from a peripheral vein, inferior vena cava and both renal veins and also to determine 24 hrs. urinary excretion of aldosterone (UEA). PRA and UEA were clasified as high, normal and low by comparing the results with those of normal subjects in a nomogram estimated in the same laboratory in which PRA and UEA values were correlated with 24 hrs. urinari sodium excretion. Besides, R greater than /R less than index (highest PRA of renal vein blood/PRA of contralateral renal vein) and V-A A index (V = PRA of renal vein blood; A = PRA of inferior vena cava) were calculated. Forty eight and thirty eight percentage of the cases had either high renin in peripheral venous blood or high UEA. Similar data in patients with essential hypertension previously studied in the same laboratory were 12 and 10% respectively. V-A A index was incongruent with the arteriographic image in 3 cases of group B; 4 cases of group A and 2 of group B had a pattern of bilateral stenosis, and one case in each group A and C had a unilateral stenosis pattern. In the other patients the samples were "non representative" due to a high level of PRA in the inferior vena cava blood comparable to PRA of the renal veins. Six cases of group A had a R greater than /R less than index superior to 1.5, which suggested a predominant vascular lesion in one side not always congruent with the arteriographic findings. In 3 cases of group B this index was higher than 1.5 in favor of the ipsilateral lesion. Three cases of group C had a normal R greater than /R less than index and one with a total oclussion of a segmental artery presented an index superior to 1.5, ipsilateral to the lesion. The latter index was of value in the diagnosis of renovascular arterial hypertension.


[Auricular fibrillation and flutter with slow ventricular frequency. Clinical and electrophysiological study]. We have studied atrio-ventricular conduction in 9 patients with atrial fibrillation and flutter and ventricular response below 90 per minute, by means of His bundle electrograms. Despite the finding of intraventricular conduction defects in 6 cases, the block of the atrial impulses occurred at the high atrio-ventricular junction in every case. In four patients the arrhythmia was an incidental finding and there were no other signs of cardiac disease. Several patients tolerated low ventricular rates for years without symptoms, but in two cases it was necessary to insert a pacemaker to treat cerebral ischemic symptoms. The problems of interpretation of the His bundle electrogram, in the presence of atrial fibrillation, are discussed in detail.


Distressing side-effects of minocycline hydrochloride. Minocycline hydrochloride is a tetracycline derivative that has been advocated as the drug of choice in the treatment of meningococcal carriers. Recently, we studied a group of 30 patients who experienced a large number of side-effects after receiving minocycline for treatment of meningococcal meningitis. Twenty-seven of 30 (90%) suffered from dizziness, vertigo, ataxia, weakness, nausea, and vomiting. These symptoms appeared within the first 72 hours of taking minocycline, and disappeared within 48 hours of stopping the medication.


[Ulterior observations on the use of C3 in acute myocardial infarction: 105 patients were treated within the 1st 6 hours after the symptoms started]. Two homogeneous groups of patients with acute myocardial infarction were observed within the first six hours from the coronary attack. On admittance and for ten days, 105 patients were treated with C3: the mortality rate resulted in 13.3%. The control group of 108 patients showed a mortality of 18.5%. Strict criteria of randomization were followed in allocating patients to the two groups. Although the difference is not statistically significant it is however interesting since it confirms a previous research. Statistically significant differences between the two groups were observed in all surviving patients in the injury signs regression time and in the cardiac volume in favour of the group treated with C3.


Diffuse skeletal abnormalities in Forestier disease. Forestier disease, or ankylosing hyperostosis, is a common disorder of middle-aged and elderly persons. Characteristic clinical and radiographic features enable the physician to distinguish between this disease and ankylosing spondylitis. The principal clinical features include aching spinal stiffness with relative preservation of function and minimal evidence of spinal immobility. Many patients have elbow and heel pain and dysphagia. Typical radiographic findings are ligament ossification, para-articular osteophytosis, and bone production at sites of tendon and ligment attachment in spinal and extraspinal locations. The extraspinal roentgenographic manifestations are so characteristic that when present, they allow the diagnosis of spinal ankylosing hyperostosis to be suggested, even in the absence of axial radiographs.


[Pulmonary atresia with intact interventricular septum. Study of 28 cases]. The present report is based on the study of 28 cases of pulmonary atresia with intact ventricular septum, all of them necropsically and/or angiographically verified. A microscopic study of the wall of both ventricles was performed in the 20 necropsy cases. The size of the right ventricular cavity, a fact of great surgical significance, did not correlate with the electrocardiogram and varied from diminute to very large. In two cases necropsically proved there was as associated atresia of the infundibular, in one of them existing additionally an Ebstein malformation of the tricuspid valve, which could be angiocardiographically diagnosed. The surgical mortality, in our hands, is 64.3%. All survivors have a small right ventricle.


Inhibition of platelet aggregation by alpha1-acid glycoprotein. In view of known abnormalities of plasma proteins in diseases showing changes in platelet aggregation, the effect of one of the major serum proteins, alpha1-acid glycoprotein, on platelet aggregation was evaluated. This protein, when added to platelet-rich plasma, markedly inhibited platelet aggregation induced by both adenosine diphosphate (ADP) and epinephrine. Transferrin, similarly studied, had no effect. These results are consistent with the hypothesis that the relative concentration of alpha1-acid glycoprotein may influence platelet aggregation in diseases associated with abnormal concentrations of this protein.


Trace element contamination of intravenous solutions. The trace element content of various intravenous solutions was investigated, using atomic absorption and neutron activation analysis methods. The variable content of zinc, calcium, and magnesium led us to seek a source of contamination. Quantities of zinc ranging from 10.75 mug to 132 mug were leached from the rubber stoppers when placed in 0.1N nitric acid for a period of 96 hours. Calcium and magnesium were also leached from the stoppers, but in lesser amounts.


Determination of serum gentamicin sulfate levels: ordering patterns and use as a guide to therapy. Determination of serum gentamicin levels (SGLs) is helpful in monitoring therapy in patients receiving this drug because there is a narrow therapeutic margin and serum levels may vary greatly between patients receiving similar doses. During a ten-month period, definite indications for obtaining SGL determinations were present for 189 of 212 serum samples (89.2%) submitted to the laboratory. However, 110 samples (51.9%) were improperly drawn and results of 85 samples (40.1%) were ignored. Only 26 of the 62 correctly drawn and not ignored samples (41.9%) were appropriately acted on. At most, 42 of the 212 samples (19.8%) were appropriately used in making patient-care decisions. Thus, in this study, an inordinatley large number of SGLs were incorrectly drawn, apparently ignored, or inappropriately used in making patient-care decisions.


[Angiocardiographic and clinical development of Carpentier's mitral rings]. Carpentier's ring was inserted in the mitral annulus of 79 patients suffering from mitral valve disease. 49 other patients also underwent surgery on other cardiac valves and are not considered in the present study. The mean follow up time was 19.5 months. The total hospital and late mortality in the isolated ring series was 3.8%. Clinical and hemodynamic improvement was evident postoperatively. The preoperative functional class (NYHA) of the patients was: I, 11.39%; II, 45.5%; III, 34.1%; IV, 8.86% respectively. The postoperative class was: I, 86.8%; II, 7.9%; III, 3.9%; and IV, 1.3% respectively. Postoperative hemodynamic and angiocardiographic evaluation was done in 27 patients. Mean pulmonary artery pressure fell from 49.8 +/- 2.4 mm. Hg to 38 +/- 2 mm. Hg. Mitral regurgitation present preoperatively in 66.6% of cases was present in residual form in only 18.5%. Atrial enlargement was moderate in 42.1% and severe in 57.9% before operation, and 80.3 moderate and 19.7 severe after operation. Tromboembolic accidents occurred in 2 patients (2.2%) both with severe atrial enlargement and atrial fibrillation pre and postoperatively. We conclude that Carpentier's ring is a valid alternative in the surgery of mitral valve disease.


Comprehensive health care clinic for hemophiliacs. One hundred hemophiliacs were examined at a formal comprehensive health care clinic. Sixty-eight percent had abnormal results of liver function tests, and 26% had spleens that were palpable. Measurement of range of motion of knees, ankles, hips, shoulders, and elbows showed a high incidence of hemophilic arthropathy and established a precise baseline by which to judge efficacy of therapy. Results of dental examination disclosed a 14% incidence of multiple severe caries, which is an incidence lower than that of the population as a whole. Examples of inadequate dosage of replacement therapy (16%) and chronic delay in application of self-therapy (14%) were discovered. An 8% incidence of hypertension was noted; prior experience suggests that the combination of hypertension and hemophilia may be lethal. Other clinical and laboratory data also illustrate the importance of a periodic, formally structured, comprehensive examination of hemophiliacs.


Primary inferior vena cava thrombosis: report of nine cases. All cases of inferior vena cava obstruction diagnosed at the Mayo Clinic between 1950 and 1973 were reviewed. Diagnosis was confirmed by surgery, phlebography, or postmortem examinations in 64 cases; the cause in 55 cases is described. Carcinoma of the kidney was the most common cause (31% pf cases). In nine cases, extensive laboratory investigation failed to reveal the cause of the process. These cases were considered to be primary inferior vena cava thrombosis and are reviewed in detail.


Acute myocardial infarction in an American traveler in China. While traveling in a rural province of the People's Republic of China, an American scientist had an acute myocardial infarction that was complicated by ventricular tachycardia and congestive heart failure. Medical personnel were rapidly mobilized, and an improvised coronary care unit was created around the patient. He survived due to the organization, training, and skill of the Chinese medical staff.


Tickborne oculoglandular tularemia: case report and review of seasonal and vectorial associations in 106 cases. A patient acquired tickborne oculoglandular tularemia in early summer in rural Virginia. Tick exposure may be a clue to the diagnosis of tularemia in the eastern as well as the western United States, especially in summer months. A review of the experience with tularemia in Virginia for the last 13 years shows a bimodal seasonal incidence of tularemia with an associated vector exposure in 77.4% of 106 cases. The majority of cases occurring during winter months have been associated with rabbit exposure, while those in summer months are often associated with tick exposure.


Respiratory paralysis during treatment of hypertension with trimethaphan camsylate. Four cases are reported in which respiratory arrest occured coincident with the intravenous administration of large doses of trimethaphan camsylate (Arfonad) to control hypertension. The mechanism of the respiratory depression is unknown, but it may have been related to a direct effect of trimethaphan on the respiratory center or to a curare-like effect of the drug. Close monitoring of ventilatory capacity should be maintained in all patients treated with trimethaphan.


Goodpasture syndrome: recovery after severe renal insufficiency. A 22-year-old woman developed the sudden onset of cough, dyspnea, blood-tinged sputum, and bilateral fluffy infiltrates on her chest x-ray film, together with severe iron deficiency anemia. Urinalysis initially revealed normal values, but gross hematuria developed on the 12th day. Linear deposits of IgG and C3 were present in the GBM; circulating anti-GBM antibodies were also observed initially but had disappeared 13 months later. Hemodialysis was performed because of oliguria and a rising serum creatinine value. She subsequently had a diuresis; 18 months later, the creatinine clearance was 63 ml/min. The anti-GBM antibody response appears to be transient, lasting only a few months, so that if the patient survives the initial insult, stabilization and even some recovery may ensue. Had this patient undergone immediate nephrectomy as part of her initial therapy, the observed favorable outcome would have been denied.


Therapeutic renal arterial occlusion for elimination of proteinuria: 'medical nephrectomy'. A patient with severe nephrotic syndrome who was too debilitated to undergo surgical nephrectomies, underwent therapeutic bilateral renal artery occlusion by the selective injection of isobutyl 2-cyanoacrylate into the renal arteries. The therapy resulted in dramatic cessation of urine flow and elimination of proteinuria.


Glossopharyngeal neuralgia with cardiac syncope: treatment with a permanent cardiac pacemaker and carbamazepine. Cardiac synope was associated with glossopharyngeal neuralgia in an elderly woman. The patient also manifested severe carotid sinus sensitivity. Permanent demand pacemaker and carbamazepine therapy were used successfully to alleviate the symptoms.


What residents do after graduation.

What residents do after graduation. This article reports the results of an investigation of the professional activities of graduates of National Institute of Mental Health-supported residency programs, spanning the five-year period 1968 to 1972. The results explode the mythical notion that the majority of such trainees enter straightway into the private practice careers. In fact, the majority devote at least half-time to some type of public-service psychiatry, with no less than 43% in full-time public service.


Alumni of the Massachusetts mental health center residency training. In a preliminary survey, 484 alumni of the Massachusetts Mental Health Residency Training Program from 1912 to 1967 were surveyed. Approximately 80% were found to have devoted half or more of their professional time to the nonprivate practice of psychiatry for at least one year. These data suggest that a training program with strong academic traditions might produce a preponderance of publicity of oriented psychiatrists. Since previous surveys have indicated a greater proportion of psychiatric time spent in private practice, we suggest that future surveys of psychiatric manpower need to consider the orientation of residency training programs in order to accurately assess the need for future psychiatric manpower.


Outcomes of psychiatric residency training during the past decade. An assumption has existed that training in a psychoanalytically or psychodynamically oriented residency program would narrow the range of the trainees' interests and limit career pathways with a predominance of private practice. In order to test this assumption, a survey was undertaken of graduates of a psychoanalytically oriented program over a ten-year period with a view to determining the nature of their present professional activities. Results of the survey were compared to available national statistics for patterns of psychiatric professional practice and prove the assumptions to be invalid. We discuss some implications of this study and possible alternate explanations for the professional practice patterns that have emerged.


The disturbed and the disturbing psychiatric resident. Two hundred psychiatric residents who were in training during a 25-year period were retrospectively studied. We found that residents could be meaningfully divided into the four following categories: (1) neither disturbed nor disturbing; (2) disturbed and disturbing; (3) disturbed but not disturbing; and (4) disturbing but not disturbed. There is a need for early recognition of disturbed residents in order to guide them into appropriate treatment, supervision, and career choice. Some very disturbed residents make a satisfactory adjustment to residency and psychiatric practice. Certain disturbing residents are not at all disturbed but are mislabeled as such by faculty. These residents often make outstanding psychiatrists. Personal psychotherapy is an important factor in the eventual outcome of the lives and careers of disturbed residents.


More on pseudoscience in science and the case for psychiatric diagnosis. A critique of D.L. Rosenhan's "On Being Sane in Insane Places" and "The Contestual Nature of Psychiatric Diagnosis". Rosenhan's 1973 article, "On Being Sane in Insane Places," was pseudoscience presented as science. Just as his pseudopatients were diagnosed at discharge as having "schizophrenia in remission", so a careful examination of this study's methods, results, and conclusions leads to a diagnosis of "logic in remission." Rosenhan's study proves that pseudopatients are not detected by psychiatrists as having simulated signs of mental illness and that the implementation of certain invalid research designs can make psychiatrists appear foolish. These rather unremarkable findings are irrelevant to the real problems of the reliability and validity of psychiatric diagnosis and only serve to obscure them. A correct interpretation of his own data contradicts his conclusions. There are purposes to psychiatric diagnosis that Rosenhan's article ignores. His more recent suggestion that certain requirements be met prior to the adoption of a new psychiatric classification system is unrealistic.


Schizophrenia--a follow-up study of results of treatment. I. Design and other problems. This is the first of a series of articles on a follow-up study of the results of treatment of schizophrenia, studied over a period of two to five years after first admission and first release. The study compares the follow-up outcome of five different treatment methods given to first-admission male and female schizophrenic patients in the hospital. The design of the study is used as a basis for description and discussion of the practical, ethical, and statistical problems involved. A distinction is made between follow-up and continued treatment design, and it is concluded that both pose massive problems in execution, analysis, presentation, and interpretation.


Schizophrenia--a follow-up study of results of treatment. This is the second article from a study of the outcome of five different methods of treatment for schizophrenia; patients were followed up over a period of two to five years after first admission and the first release. Patients who had been originally treated in hospital with psychotherapy alone stayed longer in hospital over the follow-up period than those who had received electroconvulsive therapy (ECT), drug alone, or drug plus psychotherapy. Those who had been treated with milieu therapy also had a longer stay dated from the time of admission. Patients treated initially with drugs or ECT showed a trend toward spending less time in hospital after their release.


Variability in schizophrenia. Reflection of a regulatory disease. The clinical course, body weight, biological measurements, and responses to neuroleptic agents were examined in 92 chronic schizophrenics over a period of ten years. The individual occurrence of periodic exacerbations, shifts in symptoms, changes in drug responses, unusual fluctuations in body weight, and transient biological abnormalities led me to conclude that schizophrenia is characterized by an independent variability of clinical and biological features. This variability indicates that schizophrenia is a disease of regulation.


Another view of schizophrenia subtypes. A report from the international pilot study of schizophrenia. Schizophrenia subtypes are defined predominantly my manifest symptoms and behavior. This report, based on sign and symptom data from the International Pilot Study of Schizophrenia, addresses three questions: (1) Are traditional subtype diagnoses applied similarly across cultures? (2) Are the various traditional subtypes symptomatically distinguishable from one another? (3) Can cluster analytic techniques define a more distinctive set of schizophrenic subgroups? Present State Examination data were reduced to 27 psychopathologic signs and symptoms. Profile analysis of variance results indicate that each subtype appears similar, regardless of center of origin. However, this is based on a lack of distinguishing features between different subtypes. On the other hand, when a cluster analytic technique was used, it showed one large and three small subgroups, each readilty distinguishable from the others. These subgroups, labeled "usual," "flagrant," "insightful," and "hypochondriacal," are described clinically. If replicated or validated, such subgroups may prove meaningful in future considerations of subdivisions of the schizophrenia syndrome.


Biofeedback therapy for migraine headaches. We studied the biofeedback treatment of migraine headaches, attempting to control for some of the methodological limitations of previous work. Seven individuals suffering from migraine headache were trained in the usual finger warming procedure with the omission of autogenic phrases. Additionally, to control for placebo-expectance effects, three of these subjects received training in finger cooling prior to warming. With training in finger warming, headache activity was substantially reduced. In contrast, headache activity either remained at base line levels or increased during training in cooling despite positive therapeutic expectations. The results of this study indicate that finger temperature warming, without autogenic training, is effective in reducing migraine activity, independent of suggestion effects.


Methylphenidate effects in learning disabilities. Psychometric changes. Sixty-one children of average intelligence with appreciable learning lags, but no behaviour disorders, received placedo or methylphenidate hydrochloride for a 12-week period. Methylphenidate was instrumental in improving performance on many psychological tests, but did not affect performance on standardized achievement tests. None of the patient characteristics investigated was stringly predictive of drug effect. Methylphenidate seems to have a specific effect on visualmotor processes, which in turn positively affect performance tasks, but not verbal tasks. Under the conditions of this study, methylphenidate treatment alone did not emerge as a useful agent for the amelioration of reading performance, although the data provide evidence for stimulation effects on children's cognitive functions.


Hyperactive boys and their brothers. A 25-year follow-up study. Twenty men, who had conformed to diagnostic criteria for the hyperactive child syndrome 20 to 25 years ago, and their brothers were interviewed. A large majority of men who were hyperactive had completed high school, and each was steadily employed and self-supporting. Half of the men who were hyperactive continued to show a number of symptoms of hyperactivity. Nearly half had problems of a psychiatric nature and despite normal intelligence quota scores and levels of education, these men had not achieved a socioeconomic status equal to that of their brothers or their fathers. Our findings suggest that emotional problems in everyday living may result from the persistance of symptoms of hyperactivity and that most social and psychiatric consequences of the disorder relate to its presence in childhood as well as to its persistance in adulthood.


Serum creatine phosphokinase activity in psychiatrically hospitalized children. Serum creatine phosphokinase (CPK) activity was determined in a series of 101 sequential admissions to the Pritzker Children's Hospital, an inpatient psychiatric facility. Black children had significantly higher serum CPK levels than whites, and males had significantly higher levels than females, as is the case with adults. There was a higher incidence of CPK elevations in children with organic brain pathology than in children with personality disorders or schizoprenia. Children with chronic symptoms of a psychotic nature did not have increased serum CPK activity, which is similar to the findings in adults. There were no children in the sample with acute psychotic symptoms, so it was not possible to determine whether acute psychosis in children is accompanied by increased serum CPK activity, as it frequently is in psychotics over the age of 17.


Outcome following therapeutic abortion.

Outcome following therapeutic abortion. Psychological outcome of abortion was studied in 102 patients, measuring multiple variables over four time intervals. Five measured affects--anxiety, depression, anger, guilt, and shame-were significantly lower six months after the preabortion period. The following variables describe subgroups of patients with significant variations in patterns of responses as indicated by changes in affects: marital status, personality diagnosis, character of object relations, past psychopathologic factors, relationship to husband or lover, relationship to mother, ambivalence about abortion, religion, and previous parity. A complex multivariate model, based on conflict and conflict resolution, is appropriate to conceptualize, the unwanted pregnancy and abortion experience. Data suggest that women most vulnerable to conflict are those who are single and nulliparous, those with previous history of serious emotional problems, conflictual relationships to lovers, past negative relationships to mother, strong ambivalence toward abortion, or negative religious or cultural attitudes about abortion.


Electroencephalographic correlates of oral contraceptive use in psychiatric patients. Previous studies have pointed to wake electroencephalographic changes associated with oral contraceptives. This investigation sought to determine if sleep EEG activation would show additional EEG-oral contraceptive relationships not previously suspected. With blind procedures, oral contraceptive and EEG data were collected on 110 adult women. Three age-equated comparison groups were formed: (1) never used pill (control); (2) previously used pill without side effects (asymptomatic); and (3) previously used pill with side effects (symptomatic). Analyses indicated a significant statistical relationship between paroxysmal EEGs and symptomatic pill use. No difference in paroxysmal EEG incidence existed between control and asymptomatic pill use groups. Among prior pill users, women with paroxysmal EEGs reported almost twice the side effect incidence (81.3%) as did women with normal EEGs (42.1%).


Sex conversion surgery in a man with severe gender dysphoria. A tragic outcome. Although hundreds of "sex transformation" operations have been performed, little is known about the long-term postoperative adjustment. Available outcome data suggest that sex reassignment surgery in male patients is followed by a better social as well as inner adjustment in the vast majority, at least for the first several years after surgery. Surprisingly, only a handful of cases with poor outcomes have been reported. This report concerns a 53-year-old biological male with a life-long gender dysphoria who, although subjectively pleased with the surgery, developed a paranoid psychosis five years after sex conversion surgery.


Concurrent psychotherapy and behavior therapy. Treatment of psychoneurotic outpatients. The feasibility and effects of treating psychoneurotic outpatients with concomitant but separate treatment programs of psychoanalytically oriented psychotherapy and behavior therapy was investigated in three cases, utilizing detailed clinical observations and questionnaire responses. The two treatment regimens appeared to have synergistic effects, and anticipated difficulties, such as a split therapeutic alliance, symptom substitution, or preciptious withdrawal from psychotherapy after symptom removal, did not occur. Although there was no evidence of symptom substitution after the behavioral removal of the "target symptom," both clinical observations and questionnaire responses indicated that successful behavior therapy had many unanticipated effects on the patient's nontarget behaviors and cognitions.


The global assessment scale. A procedure for measuring overall severity of psychiatric disturbance. The Global Assessment Scale (GAS) is a rating scale for evaluating the overall functioning of a subject during a specified time period on a continuum from psychological or psychiatric sickness to health. In five studies encompassing the range of population to which measures of overall severity of illness are likely to be applied, the GAS was found to have good reliability. GAS ratings were found to have a greater sensitivity to change over time than did other ratings of overall severity or specific symptom dimensions. Former inpatients in the community with a GAS rating below 40 had a higher probability of readmission to the hospital than did patients with higher GAS scores. The relative simplicity, reliability, and validity of the GAS suggests that it would be useful in a wide variety of clinical and research settings.


A scanning electron microscopy of subcellular structures of the human hepatic cell. Human liver specimens obtained by needle biopsy were extensively osmicated by the revised tannin-osmium method of MURAKAMI (1974) and cracked in air after critical point drying, to be observed in the scanning electron microscope. The fracture tended to occur along the membranous elements and exposed beautifully fractured faces of the hepatic cell. The nucleus of the hepatic cell was spherical. The nuclear pores were demonstrated as small pits 0.1 mu in diameter and their total occurrence in one nucleus was estimated to be 2,100. In the spongy framework resembling the endoplasmic reticulum, oval-shaped mitochondria and multivesicular tufts of the Golgi complex were observed. The nucleolus of the hepatic cell nucleus was noticed as a highlighted mass in the cloudy nucleoplasm.


Histological study on the postnatal development and sequence of eruption of the mandibular cheek-teeth of rabbits (Oryctolagus cuniculus). The postnatal development and sequence of eruption of mandibular cheek teeth of rabbits were studied by histological methods. Hemi-mandibles were dissected and sectioned in longitudinal sections of 7 mu and stained with hematoxylin-eosin and Masson's trichrome. The presence of two mandibular deciduous molars which are replaced by corresponding premolars and of three mandibular permanent monofisary molars was confirmed. Eruption of deciduous molars of the mandible begins at 4 days after birth and of the mandibular permanent molars at 9 days, while that of mandibular premolars occurs at 23 days, replacing the mandibular deciduous molars which have exfoliated. At 32 days all the mandibular permanent cheek-teeth are erupted. At birth the mandibular deciduous molars are completely developed and at 4 days their root resorption is initiated. At the first day P3 is in the bell stage and the P4 has begun dentinogenesis. In M1 and M2 amelogenesis is observed.


Some electron microscope findings of the claustrum of the cat. The claustrum of the cat is basically composed of 4 classes of neuron. Class I is a rather small neuron (less than 10 mu in diameter) and is provided with rather few cytoplasmic organelles, while Class IV, large (25-30 mu), neuron possesses an abundance of them. Class II, medium-sized (15-20 mu), neuron and fusiform Class III neuron (about 15 X 25 mu) exhibit an intermediate form of the former two classes. Perikaryal and proximal dendritic surface of Class IV neurons are covered with many boutons, while neurons of the other three classes have few of such terminals on their perikaryal surface. The dendritic profiles of rather reduced diameter bear a few axonal terminals. Five types of terminals are recognized: (1) Type A terminal, small in profile, with uniform sized round vesicles (about 300 A in diameter) making asymmetrical synapses; (2) Type B terminal of small size, containing round vesicles of various diameters (300-400 A) and forming asymmetrical synaptic contacts; (3) Type C, also small in profile, being filled with pleomorphic vesicles and making symmetrical synapses; (4) Type D large terminal with numerous pleomorphic vesicles, many mitochondria and a number of glycogen-like granules, forming symmetrical synapses; and (5) Type E terminal containing numerous granular vesicles (800-1,000 A). The Type C and some of Type A terminals usually synapse upon the cell bodies and proximal dendrites, while most of Type A, B, D and E make synapse upon medium to small dendritic profiles and spines. The problem whether or not the cytoarchitecture of the claustrum at the light microscope level is identifiable at the ultrastructural level as well, and the possible origin of various types of terminals above described, were discussed briefly.


A scanning and transmission electron microscopic study on rat bone marrow sinuses and transmural migration of blood cells. Bone marrow sinuses of young rats were examined under the scanning (SEM) and transmission electron microscopes (TEM). Marrow sinus wall was composed of three layers: an inner or luminal endothelium, an outer or adventitial cell layer, and a basal lamina in between. The luminal surface of the endothelial cells was quite smooth and showed some fenestrations, which could be divided into two types according to their size. One was represented by larger fenestrations (1-3 mum in diameter) which were presumed to be formed transiently at the site of blood cell migration, while the other by small pores (0.1 mum) grouped into a cribriform area. The adventitial cells showed a discontinuous layer in the TEM. Under the SEM, the discontinuity corresponded to the spaces formed between the cytoplasmic attenuations of the cells. Blood cell migration from the extravascular hemopoietic tissue into the sinus lumen was numerously observed. The migration occurred not through an intercellular gap, but through the larger intracellular fenestration of the endothelial lining mentioned above. A number of megakaryocytes were identified by their bulky cytoplasm in the parenchyme. Figures suggesting the sequence of platelet liberation from this cell could be demonstrated. First, the megakaryocyte extended its peripheral cytoplasmic processes into the sinus through endothelial fenestrations. The processes, being conspicuously extended, became periodically constricted. Finally, platelets were believed to be produced by separation at the constricted portions and liberated to circulation. The occurrence of a few endothelial fenestrations apparently unassociated with blood cell migration may possibly be ascribed to detachment of a blood cells due to vascular perfusion. The functional significance of the adventitial cell was discussed in association with blood cell migration.


Exercise prescription: role of the physiatrist and allied health professional. The prescription of exercise has advanced from an art to a science. The patient must first be examined by a physician to determine if there are contraindications to participating in an exercise program. This examination should include a graded exercise test to volitional fatigue to determine the normality of the electrocardiogram response to exercise and to assess the patient's capacity for exercise. Once the patient has received medical clearance, an exercise program is prescribed. This prescription is based on the individual's exercise capacity and includes a definition of the type, frequency, duration and intensity of exercise. Each of these four factors is discussed in detail and the potential role of the physiatrist, therapist, and allied health professional is defined.


Mechanical work and fatigue: their roles in the development of muscle work capacity. To compare the effects of mechanical work versus fatigue on the improvement of work capacity of muscle, young, healthy men were selected to life a 45-pound weight with their quadriceps for 30 sessions, followed by 5 sessions of testing. The study consisted of two phases. Subjects in the first phase did equal amounts of mechanical work with both quadriceps, but had different amounts of fatigue from side to side because the rate of work was different. Subjects in the second phase fatigued both quadriceps, but one quadriceps was fatigued with a rest period between contraction cycles, and one was fatigued without a rest period, thus allowing the side with the rest cycle to do more mechanical work. To test the relative effects of training, a transfer-of-training design was used in both phases. The results suggest that fatigue, defined operationally as the inability or unwillingness of the subject to continue the prescribed task under given reinforcement conditions, plays a larger role in the development of work capacity of muscle than the amount of mechanical work per se.


Measurement of motor unit action potentials: procedural considerations. Many factors influence the observed magnitude and shape of motor unit action potentials (MUAP). Several of these are related to procedures used during the electromyographic examination. An examiner must be aware of the procedural factors which may alter his observations. These include the following: strength of contraction; placement of the ground and reference electrodes; site, depth and pattern of electrode penetration; distance of active electrode penetration; distance of active electrode discharging unit; and separation of observation sites. The number of different MUAP observed and the number of observations of each MUAP become important when formulating a statistical report. The acceptable level of variation between serial samples of the same motor unit may determine the number of  different units available for analysis. The selection of the point where the MUAP begins, ends and deflects maximally can influence the recorded observations.


Sociopsychological factors influencing response to levodopa therapy for Parkinson's disease. This article examines the effect of a series of physical and sociopsychological variables on the response shown by Parkinson patients to levodopa therapy. Of the ten major variables examined, six measure relatively enduring personality adaptations: suggestibility, passivity, self-expectations, stigma, attitudes toward illness, and the perception of the expectations of others. Four are illness-related characteristics: diagnosis (primary or secondary parkinsonism); the existence of health problems in addition to Parkinson's disease; whether or not the patient was hospitalized at the beginning of treatment; and symptom improvement as rated by the patient's physician. Age, sex, severity and duration of disease, and use of anti-Parkinson drugs in addition to levodopa were controlled in all of the analyses. The effect of levodopa therapy was assessed in four major areas: activity, social participation, depression, and enjoyment of life. Findings can be summarized as follows: Five of the six personality variables do, in fact, modify the amount of social or psychological change shown by Parkinson patients treated with levodopa. The only one which fails to have such an effect is passivity; this may reflect a measurement problem. However, only two of the four illness-related characteristics which were examined made a difference in treatment outcome: diagnosis and symptomatic improvement, as rated by the patient's physician.


Left ventricular function during aortic surgery. Fourteen patients undergoing surgery for aneurysm or occlusive disease of the abdominal aorta were studied. Thirteen patients had a history of hypertension or myocardial infarction; two patients had chronic obstructive pulmonary disease. Tachycardia, hypertension, and elevated pulmonary artery occluded. (PAo) pressure occurred in response to laryngoscopy and intubation in two patients; elevation of PAo pressure in response to aortic cross-clamping occurred in two patients. In three of these four patients, electrocardiographic evidence of myocardial ischemia appeared. These events are important in a consideration of the occurence of myocardial infarction in patients undergoing abdominal aortic surgery. Satisfactory treatment of myocardial ischemia has been accomplished with the use of propranolol hydrochloride and sodium nitroprusside.


Acute management of the upper airway in facial burns and smoke inhalation. Among 740 patients with acute burns who were admitted to our burn center from 1972 through, 1975, thirty-six required upper airway access within the first 24 hours after burn for oral and facial burns or smoke inhalation. Nasotracheal intubation was initially used. Twelve survived; 11 were successfully extubated and one required a tracheostomy. If the patient had not sustained major smoke inhalation, extubation was usually possible without tracheostomy when edema subsided between one and six days after the burn. It is concluded that endotracheal intubation is a satisfactory method of gaining airway control in severe oral and facial burns and in smoke inhalation. The mortality associated with orofacial burns or smoke inhalation is related to the degree of lung damage, patients' s age, and the extent of the burn; it is not related to the method of upper airway control.


Fruit pit obstruction. "The propitious pit.". Ingestion of fruit pit must be a frequent and innocuous phenomenon, judging from the expected frequency of such occurrences and the relative dearth of medical reports to the contrary. Reported here are four cases in which fruit pits of varied nature completed an otherwise incomplete intestinal obstruction. On of these was in the terminal ileum, with incomplete obstruction due to regional ileitis, in which the offending pit was seen radiologically but was not recognized as such. The other three were in the transverse colon, at the site of annular carcinomatous lesions. The completion of the obstruction by the fruit pits eventuated in earlier symptoms, diagnosis, and treatment. In one case, the fruit pits were multiple; in the remainder, they were single.


Vascular manifestations of the thoracic outlet syndrome. A surgical urgency. Although the vascular manifestations of the thoracic outlet syndrome are infrequent, their presence is an ominous portent for the affected limb. The cases of two recent patients indicate the importance of prompt recognition, urgent angiography, and definitive surgery. Regarding the surgical procedure, we used a two-incision approach-supraclavicular and intraclavicular-combining scalenotomy, resections of the cervical rib if present, the first thoracic rib, and the subclavian artery with retroclavicular interposition woven Dacron graft reconstruction. Preceding graft replacement, a Fogarty catheter thrombectomy of the distal brachial artery tree is done with completion arteriography to ensure freedom from retained distal thrombus. First rib resection is easily performed; subsequent vascular repair is also carried out, using this approach. We did not add sympathectomy to these cases, believing that early recognition and treatment will obviate its necessity. Follow-up has supported the efficacy of the treatment plan as presented.


Effect of cardiac dysrhythmia on cerebral perfusion. Extracranial carotid arterial obstructive disease has been the entity most commonly associated with transient cerebrovascular insufficiency. A nonobstructive, frequently overlooked cause of cerebral ischemia is cardiac dysrhythmia. We have explored this by observations of experimental animals and of man. Blood flow and pressure in the carotid arteries of dogs were shown to be decreased by mechnically induced premature ventricular contractions. The significance of the cardiogenic contribution to altered cerebrovascular perfusion was studied by ocular and brachial plethysmography in 210 patients suspected by history of having carotid arterial insufficiency. Of the 210 patients, 62 demonstrated abnormal ocular plethysmographic recordings, and of those, nine had dysrhythmias associated with significant deficits of ocular perfusion. Five patients whose recordings were technically suitable for publication are presented to demonstrate the bizarre ocular plethysmographic recordings seen during the dysrhythmic cycle.


Dilation of esophageal strictures. A new technique controlled by fiberoptic endoscopy. Dilation of peptic esophageal strictures visually controlled by means of fiberoptic endoscopy was carried out in 16 patients. The dilation was performed by passing the woven silk bougies alongside the endoscope, so that the process could be observed in detail. The technique affords a better view of the procedure because of a wider visual angle and because the field of vision is not blocked by the bougie, as would be the case with the rigid endoscope. The size of the bougie employed is not limited by the size of the endoscope. All 16 patients, with and without subsequently undergoing Nissen fundoplication, were able to eat a normal diet after therapy.


Narrow lumbar spinal canal with "vascular" syndromes. Symptoms suggestive of vascular origin, both venous and arterial, may be the presenting complaints in patients with lumbar spondylosis. Fourteen patients suspected of having vascular intermittent claudication were found to be free of vascular disease, but had cauda equina compromise from herniated disk, osteoarthritis, and hypertrophic ligaments. Complete follow-up data were available for seven  patients. In three, claudication seemed typical; in four, atypical. At operation, herniated intervertebral disks, osteophytic bone, or hypertrophied ligamenta flava, or a combination, were found. All benefited from lumbar laminectomy. When patients with vascular-like symptoms are found to be free of arterial or venous disease, lumbar spondylosis (narrow lumbar canal syndrome) should be considered. Chronic incapacitation pain without vascular disease provides a clue, as does electromyography. Plain X-ray films of the lumbar spine do not show the abnormality; thus, myelography should be carried out even in the absence of neurologic signs.


False-positive gray-scale ultrasonography for intra-abdominal abscesses. Two patients had convincing mass lesions demonstrated with gray-scale echography and strongly supporting clinical evidence for intra-abdominal abscesses. Neither patient had a lesion at the time of surgery. Although modern echography is an accurate diagnostic method for intra-abdominal abscess, false-positive results can occur.


Transalveolar metabolic protection to the lung. Radioactive glucose was administered as an aerosol to isolated rabbit lungs in an artificial thorax in order to investigate the capacity of the lung tissue to metabolize substrate supplied via the airway rather than via the circulation. Comparisons were made with radioactive glucose to which insulin had been added, with aerosolized distilled water, and with lungs that were neither ventilated nor perfused. The lung tissue utilized the aerosolized glucose as substrate (linear production of 14CO2 incorporation into lipid, and maintenance of high-energy phosphate content). Addition of insulin to the glucose did not alter the values. Ventilation with aerosolized water instead of glucose significantly reduced high-energy phosphate content, and these values decreased significantly further when the lungs were not ventilated. These studies confirm the fact that substrate can be utilized from the airway side of the lung, and encourage the speculation that it might prove therapeutically useful in pulmonary failure.


Jaundice associated with polycystic liver disease. Relief by surgical decompression of the cysts. Jaundice is an unusual feature of polycystic liver disease. In a 46-year-old woman with polycystic liver disease and jaundice, the bilirubin level was 42.0 mg/100 ml. Because of the rapid rise in bilirubin level, relief of supposed obstruction of intrahepatic bile ducts was attempted by unroofing the hepatic cysts. Following operation the bilirubin level returned to normal, and the patient has remained well since.


Neomycin toxicity revisited.

Neomycin toxicity revisited. Nephrotoxicity and ototoxicity represent the most hazardous side effects of the clincial use of neomycin sulfate. Despite therapeutic restriction of the latter compound to topical, irrigant, and bowel sterilization use, serious toxicity is still encountered. A 69-year-old patient was recently treated by us for acute renal failure and total deafness induced as a result of intermittent seven-day lavage of a surgical cavity with neomycin. Peritoneal dialysis reduced the serum concentration of the antibiotic and promoted complete recovery of renal function. The patient, however, remained deaf. This case serves as a reminder that neomycin can be absorbed systemically following its use as an irrigant solution. In such cases, it may produce an unsuspected form of "high output" renal failure and concomitant hearing loss. The renal failure is usually reveesible, but the hearing loss is frequently permanent.


Drill biopsy confirmation of breast cancer. The technique of drill biopsy of suspicious masses in the breast has been used in 135 patients, with 98.5% accuracy. It has permitted discrimination in the application of expensive scanning studies. Prior confirmation of the diagnosis of carcinoma reduces operating room and anesthesia time, and eliminates the need for two sets of instruments.


Bilateral vocal cord paralysis. A complication of percutaneous cannulation of the internal jugular veins. A severe complication resulted from internal jugular cannulation. An obese patient had hematomas after bilateral attempts. The first cannulation (on the right) was successful after many tries; the second (on the left) was not. The patient was hoarse after the first attempt; more so and dyspneic after the second. Laryngoscopic examination showed paralysis of the vocal cords. Tracheostomy was done. Two weeks later, the cords were seen to move normally. The tracheostomy was removed, and recovery was uneventful.


Nonocclusive mesenteric vascular insufficiency. A 74-year-old man had probable nonocclusive intestinal ischemia after myocardial infarction. Angiography and careful monitoring of the patient's hemodynamic status allowed diagnosis and appropriate supportive treatment leading to recovery.


[An autoradiographic and electron microscopic study of fibroblasts under conditions of stimulation of the wound process]. The effect of potassium orotate on the ultrastructure of fibroblasts and synthesis of RNA by these cells in the course of healing of experimental skin wounds were studied. For this purpose, dayly there were performed autoradiographic and electron-microscopy investigations of the wound areas in animals which were dayly given 0.2 ml of a 2% solution of potassium orotate and also of those in control animals. Under the effect of potassium orotate on accelerated differentiation of fibroblasts was noted, which was accompanied by the appearance of cells with well developed granular endoplasmatic network, with intensive inclusion of a labeled precursor of RNA, earlier, as compared with controls, healing of the wounds. Moreover, the stimulator not only contributed to a more intensive synthesis of RNA, but also hastened the transfer of newly synthesized RNA from nucleus to the cytoplasm of fibroblasts in the period of activecollagenosis.


[Molecular pathology and the problem of bodily integrity]. The paper is devoted to general and special (local) problems in pathology. The author lays particular stress on the fact that, despite the achievements of molecular biology, a solution of many principal problems of pathogenesis of various diseases in man, regularities of his adaptation to diverse environmental factors, etc., can be achieved only by a synthetic insight into the whole complex of factual material seen from the standpoint of the organism as an integrated system functioning on the basis of general regulatory mechanisms, many elements of which remain still unknown. Establishing of the latter is one of the most important and most complicated present-day challenges of biology and medicine.


[Histomorphologic analysis of kidney lesions in hemorrhagic fever with renal syndrome]. Data on morphology of the kidneys in hemorrhagic fever with the renal syndrome (HFRS) are discussed. In the kidneys of 10 decreased patients (with time period from the onset of the disease till death 4--13 days), in whom the disease proceeded with azotemia and oligo-anuria, there were observed oligemia of the glomeruli with secondary changes in the cellular elements, dystrophic changes in the tubules, these changes being particularly pronounced in the proximal segment, and being accompanied by nephrohydrosis; beginning with the 4--6th day signs of regeneration, edema in the walls of vessels and swelling of a hypoxic character were noted. A distinguishing feature of HFRS was a drastic plethora of the jextamedullar zone with hemorrhages due to venous congestion. The changes in the kidneys observed in HFRS were similar to morphological changes in acute renal insufficiency (ARI) of the type of "shock kidney". A characteristic feature of API in HFRS was a high degree of sequestration of the blood flow in the medullar layer.


[Age and transformation dynamics of rectal vains and their alteration during hemorrhoid development]. Section and operative materials in persons of various age groups (108 cases in the norm and 197 cases with hemorrhoids) were investigated. Histometrically and macromicroscopically there were revealed veins of a trabecular structure and cavernous bodies in places of the most numerous contacts of the initial roots of the superior, middle and posterior rectal veins in the submucous base of anal columellas. At different stages of formation of hemorrhoids in various forms of phlebectasis (simple, varicous, and cavernous) most pronounced were histostructural changes in the form of endophlebitis and characteristic hypertrophic-atrophic processes of the media. In the process of varicous phlebectasis and formation of hemorrhoids in the cavernous form the ratio of the venous sinus wall thickness to the diameter of the lumen of the venous sinuses are drastically changed at the expense of enlargement of the latter.


[Experimental study of infectious hepatitis in guinea pigs]. The authors carried out a comparative study of morphological changes in the liver of guinea-pigs in various times following intraperitoneal administration of the serum taken from a patient with infectious hepatitis (1st group), administration of the serum in combination with the urine (2nd group), administration of the serum in combination with the patient's duodenal juice (3rd group), and administration of the serum in combination with a hepatic antigen prepared of the liver of a healthy guinea-pig (4th group). Observations over the behaviour of the animals and morphological investigations showed a high sensitivity of guinea-pigs to virus-containing materials. The reaction was particularly pronounced in animals which were given the serum taken from a patient with infectious hepatitis in combination with a hepatic antigen, and the microscopic picture of the liver almost similar to that of the patient with Botkin's disease. Moreover, in the course of the study it was found possible to re-inoculate the virus obtained from the guinea-pigs subjected to a combined exposure to the serum from a patient with infectious hepatits and hepatic antigen. Comparing the results of the study on guinea-pigs with those obtained previously in the experimental study of viral hepatitis on white rats (1970), the authors have come to the conclusion that guinea-pigs may be used for modelling and experimental investigation of Botkin's disease.


[Morphometric study of atherosclerosis of the extra- and intracranial cerebral arteries]. Visual-planimetric studies of atherosclerosis of the major arteries of the brain in 507 dead persons aged 30 years and older who had died of casual causes and diseases, were carried out. Collection and investigation of materials were conducted in accordance with the WHO programme (Uemura et al, 1964). Considerable differences in the degree of manifestation of atherosclerosis in the arteries under study and in the rate of their development in the course of life were established. The development of atherosclerosis in the extracranial arteries in men was more pronounced than in women. As to the degree of manifestation of the atherosclerotic process, incidence of stenosis of the investigated arteries inflicted more than 50 per cent of the lumen was not observed, there were no considerable differences between those who had died of complications of atherosclerosis with and without combination with hypertension. Marked pathologically convoluted and folded carotid and vertebral arteries were rare.


[Alveolar microlithiasis].

[Alveolar microlithiasis]. A total of three observations on alveolar microlithiasis are described: two in female patients aged 19 and 44, and one in a man aged 56 years. In two patients diagnosis was established following biopsy of the lung tissue, and in one--posthumously. Basing on the literature data, the authors discuss problems of pathogenesis, clinico-morphological manifestations and differential diagnosis of the disease.


[A case of fungiform mycosis with lesions of the internal organs]. A case of fungiform mycosis with involvement of the liver, kidneys, and the skin in a female patient aged 56 is described. Duration of the illness--2 months. Lesions of the skin localized on the face and upper extremities. The anamnesis revealed chronic bronchitis and bronchial asthma of a 15-year duration. The corticosteroid therapy resulted in destruction of tumour-like nodes on the skin, but the patient died because of a concomitant bilateral fibrous-purulent pneumonia. The diagnosis was established on clinical data (on bioptic specimens of the skin) and corroborated by sectional material.


[Cytospectrophotometric analysis in enzyme histochemistry (limits of reproducibility and reliability)]. The article discusses results of the investigation into variability of the thickness of sections of a non-fixed frozen tissue obtained in cryostat, the dependence of optic density of histoenzymological preparations upon the thickness of a section and duration of incubation, degree of the accuracy of measurements of the optic density by probes of a different diameter, compatibility of results obtained by various techniques of cytospectrophotometry. It is shown that when the scale of microtome-cryostat was set at 5 mcm the thickness of sections varied in the range of 10%, at 10 mcm--in the range of 2%. In preparations as thick as 10 mcm2 and more lineal interrelationships between their optic density and duration of incubation were observed. In the photometric analysis of results of tetrasole reactions the accuracy of measurement is inversely proportional to the size of the probe: M+/-m--0.27+/-0.006--0.009 with area 3.0 mcm2 and 0.27+/-0.002 fith aea 0.8 mcm2. Results of measurement of optic density of ethanol by photoelectric and photographic techniques of cytospectrophometry (on the apparatus MUF-5, MUF-6, MF-2, MF-4, IFO-451) differ in the range of 0.5%, of histoenzymalogical preparations--in the range of 5--7%. On the basis of the data obtained a conclusion may be drawn that, if certain conditions are observed, the cytospectrophotometric analysis of histoenzymological preparations will give compatible results the accuracy of which meets the requirements put in a 95% level of probability.


Immunogenetic analysis and serum viral antibody titers in multiple sclerosis. In order to investigate the possible relationships between multiple sclerosis (MS) and the factors of genetic predisposition and exposure to infectious agents, studies were undertaken in 59 male patients with MS to determine the histocompatibility antigen (HL-A) type and the serum antibody titer to rubeola hemagglutinin (HA), rubeola envelope antigen (V), rubeola nucleocapsid antigen (S), rubella, herpes simplex, cytomegalovirus, and parainfluenza 1. The incidence of HL-A7 was significantly higher, and HL-A12 incidence was significantly lower, in the MS group than in control groups. The geometric mean titers to rubeola HA and to the V and S antigens were lower in the HL-A7 positive control patients than in either the non-HL-A7 controls or the MS patients. There were no specific relationships of the rubeola titer to HL-A12. Antibody titers to the other viruses studied were not significantly different in MS patients as compared to controls, nor was there any relationship of HL-A7 or HL-A12 and serum titer to those viruses. This study provides further evidence of a genetic predisposition to MS, and of a relationship between rubeola and this disease. These findings suggests that the failure of MS to appear in individuals who might be genetically predisposed to this disorder may be related to their immune response to rubeola.


Histocompatibility (HL-A) factors in familial multiple sclerosis. Is multiple sclerosis susceptibility inherited via the HL-A chromosome? In order to study a possible hereditary factor leading to multiple sclerosis (MS) susceptibility, histocompatibility (HL-A) types were studied in families where two or more first-degree relatives had MS. Neither the inheritance of a particular parental HL-A chromosome, nor the occurrence of any specific HL-A antigens, could be shown to be necessary or sufficient for the development of MS in family members. The distribution of HL-A chromosomes was essentially the same for affected and unaffected family members. An excess of 3,7 haplotype and W21 antigen was demonstrated, both in affected patients and in unaffected family members, in equal proportions. We conclude that the HL-A chromosome has no direct causal relationship to MS susceptibility, although it may be indirectly associated by population stratification, maternal factors, or some other mechanism.


Antibodies to vaccinia and measles viruses in multiple sclerosis patients. A virologic comparison was made of 144 patients with multiple sclerosis, 34 of their healthy siblings, and 40 patients with other neurologic diseases (OND). Antibodies in serum and cerebrospinal fluid (CSF) to vaccinia and measles viruses were measured, and these were correlated in the multiple sclerosis patients with the clinical characteristics of their disease. The CSF antibody to vaccinia virus was more frequent and at a higher titer in multiple sclerosis patients than in either control group. Moreover, a statistically significant increase was found in both frequency and titer of CSF vaccinia antibody in patients with the progressive form of the disease as compared with those classified as relapsing-remitting. Statistically significant differences between multiple sclerosis patients and their siblings were not observed for CSF or serum measles virus antibody, although both groups had significantly higher serum antibody titers than patients with OND.


Neuroelectric blocking factors in multiple sclerosis and normal human sera. Serum samples from 13 multiple sclerosis (MS) patients and ten normal human serum samples were applied to cerebral neocortex cultures and evaluated for their ability to block evoked electric activity. A high proportion of sera positive for neuroelectric blocking factors was found in both groups, and there was no substantial difference between serum samples from MS patients and those from normal human volunteers. Some of the neuroelectric blocking factors were thermolabile, others were thermostable, and still others may have been complement-dependent. It is concluded that the ability to block evoked electric responses in tissue cultures is a nonspecific serum property, and that it is not specifically related to the pathogenesis of demyelinating disease.


Histocompatibility typing in amyotrophic lateral sclerosis. Histocompatibility (HL-A) phenotypes of 44 unrelated white patients from the greater Boston area with amyotrophic lateral sclerosis (ALS) and 200 white controls were compared. In the overall ALS group, an increased frequency of HL-A3 was noted (43% vs 25%, P less than .05). Thirty-eight patients had rapidly progressive disease; among this group the HL-A3 incidence was 50% (P less than .005). Six patients had slowly progressive disease, none had HL-A3, and five had HL-A12. The HL-A antigens may link with disease severity in ALS.


Cerebral dominance for consciousness.

Cerebral dominance for consciousness. In a prospective study we evaluated the relationship of level of consciousness to hemispheric side of lesion following acute cerebrovascular injury. Fifty-seven percent of patients with left hemispheric lesions had initial impairment of consciousness, in contrast to 25% with right-sided damage.


Diethylstilbestrol effects on serum enzymes and isozymes in muscular dystrophy. Diethyistibestrol was administered orally to 11 boys with Duchene muscular dystrophy (DMD). Creatine phosphokinase (CPK) and lactate dehydrogenase (LDH) activities, characteristically high in DMD, and presumably of muscle origin, were reduced significantly (P LESS THAN .05). On ther other hand, the activity of alkaline phosphatase, an enzyme not of muscle origin, increased. These enzyme changes were reversible when diethyistibestrol was discontinued. Despite appreciable alterations in totoal serum enzyme activity, no important change was found in the isozyme patterns. Piperazine estrone sulfate was administered to another patient with DMD. The effects of this physiologic hormone were, in part, similar to those of diethyistibestrol. Experimentally, diethylstilbestrol reduced the efflux of CPK and LDH from mouse skeletal muscle. This may be the manner by which diethylstilbesterol reduced the serum enzyme levels in DMD, but this has not been proved directly. These studies are the first step in an effort to identify various agents that in combinations may normalize serum enzyme levels.


Are muscle fibers denervated in myotonic dystrophy? An underlying neurogenic abnormality has recently been postulated in the muscular dystrophies. To test this hypothesis, we applied a widely accepted criterion of denervation-ie, and increase in extrajunctional acetyicholine (ACh) receptor sites--to muscles biopsy specimens from nine patients with myotonic dystrophy and three with amyotrophic lateral scierosis (ALS). The ACh receptor sites were determined by means of iodine 125-labeled alpha-bungarotoxin binding, measured by scintillation counting and autoradiography. None of the myotonic dystrophy muscles showed increased extrajunctiona ACh receptor sites, even in the smallest fibers. By contrast, muscle biopsy specimens from patients with ALS showed notably increased extrajunctional ACh receptor sites, especially in the small fibers. Our findings do not support the hypothesis of a neurogenic defect in myotonic dystrophy.


A demyelinating disorder associated with cerebrovascular amyloid angiopathy. Five patients with a demyelinating disorder and associated amyloid angiopathy are presented. The disease affected middle-aged individuals, pursued a fluctuating course, and ended in progressive, fatal deterioration of the central nervous system. Neurologic findings indicated multiple lesions within the neuraxis; profound dementia was prominent in all cases. Pathologically, numerous demyelinated plaques, similar to those in multiple sclerosis, were found in the cerebral white matter, and less consistently in other locations such as optic nerve, brain stem, and spinal cord. Amyloid accumulated massively in and around blood vessels, usually in the immediate vicinity of the plaques. At least one similar case is reported in the literature, but the nosologic status of the condition is uncertain.


Congenital muscular dystrophy as a disease of the central nervous system. Profound abnormalities of the brain were noted in a 6-year-old Japanese boy with congenital muscular dystrophy (CMD). Pathological alterations included diffuse cerebral and cerebellar micropolygyria, with bilateral temporal agyria, and abnormal fusion of gray matter in the basal portions of both frontal hemispheres. Microscopically, the architecture of both cerebral and cerebellar cortices was severely distorted, with irregular arrangement of neurons and increased vascularization. Skeletal muscles showed dystrophic changes rather than neurogenic atrophy. Eight autopsy cases of CMD with similar pathologic findings have been reported in Japan, although the lesions in the brain are quantitatively different from case to case. The findings indicate that CMD is a dysplastic disease of the central nervous system, with dystrophic involvement of skeletal muscles.


Acute choroidal ischemia as a complication of photocoagulation. Acute choroidal vascular insufficiency as a complication of photocoagulation has been little noticed. In 17 eyes of 16 patients photocoagulated with either xenon or argon sources for proliferative sickle cell retinopathy, gray lesions of the fundus developed peripheral to the photocoagulation sites. Histologic examination of similar gray lesions produced in monkeys showed necrosis and atrophy of the outer half of the retina. Intense photocoagulation of the human fundus, even with smaller spot sizes, may occlude a choroidal artery, producing separate gray lesions of distinctive shape. The lesions in both the patients and the monkeys progressed to granular hyperpigmentation by two to three weeks after photocoagulation.


Transantral-ethmoidal decompression of optic canal fracture. A case of indirect trauma to the optic nerve was successfully treated with transethmoidal decompression. The literature was reviewed, and reports of poor results from neurosurgical procedures are cited. Improved results from transethmoidal decompression of the optic nerve have been reported by Japanese authors but, in our opinion, without proper selection of cases. Early diagnosis of traumatic compression of the intracanalicular optic nerve as evidenced by delayed and/or progressive vision loss following injury, coupled with prompt transantral-ethmoidal surgical decompression, should yield gratifying results in the treatment of this uncommon condition.


Searching the literature and computerized services in ophthalmology. The individual searching the literature of ophthalmology should not find this a time-consuming or frustrating activity. The basic guides to the literature are described, and methods for obtaining information are outlined. The value of orienting oneself to each guide before using it is stressed. Special attention in this communication is given to locating current material; however, guides for searching the older literature are presented also. Since several computerized searching services can be helpful, their programs are briefly described; addresses are given for current prices and additional information. Some of the online services may be accessible in your local or regional medical library. When you become conversant with these guides and methods you will be able to find more information than before, and you will be able to find it more quickly.


Topical corticosteroid therapy and pituitary-adrenal function. Systemic absorption has been reported after the use of corticosteroid eye drops. Prolonged use could result in adrenocortical insufficiency and an associated adrenal crisis under stressful situations. For that reason, we studied the hypothalamic-pituitary-adrenal axis of patients receiving corticosteroid eye drope. Fifteen patients were given 0.1% dexamethasone sodium phosphate eye drops, one drop (approximately 1/30 ml) to each eye four times a day for six weeks. This dosage resulted in partial adrenal suppression, manifested by reduced levels of plasma cortisol. However, in each case, the hypothalamic-pituitary-adrenal axis, as evaluated with the use of the oral metyrapone tartrate test, was intact.


Cyanate-induced cataracts in patients with sickle-cell hemoglobinopathies. Two young patients developed bilateral posterior subcapsular cataracts while receiving oral sodium cyanate for treatment of sickle cell hemoglobinopathy. In one of the patients, lens opacities regressed spontaneously after cyanate therapy was discontinued.


Erythrocyte sedimentation rate and age.

Erythrocyte sedimentation rate and age. One hundred sixty-nine adult patients admitted to McPherson Hospital for elective eye or ear, nose, and throat surgery had erythrocyte sedimentation rates (ESRs) performed by the Wintrobe method, in addition to the usual admission laboratory work. The patients were selected for study if they had no known disease or were not receiving any medication that affects the sedimentation rate. The results showed that the mean ESR rose with each decade of life.


Sarcoidosis with optic nerve and retinal involvement. A patient with the typical funduscopic changes of sarcoidosis died following an accident. The histopathological findings in one eye were correlated with the ophthalmoscopic observations made several days prior to death. Gross and histopathological examination revealed that the characteristic whitish-yellow focal retinal exudates, the perivascular exudates with an appearance like candle wax drippings, the preretinal and intravitreal nodules, and the localized tumefactions on the inner surface of the retina and optic  nerve head noted ophthalmoscopically were a result of the nodular proliferation of epithelioid cells. These cells appeared to be derived primarily from blood vessels in the retina and optic nerve head. Although subpigment epithelial granulomas were found, there were no granulomas present within the choroid or elsewhere within the uvea.


Scleral tuberculosis.

Scleral tuberculosis. A case of scleral tuberculosis was successfully treated by combined systemic and local therapy. The importance of biopsy for early diagnosis and initiation of curative treatment is stressed.


Sato needling for pupillary membranes.

Sato needling for pupillary membranes. Dense pupillary membranes are resistant to needle-knife incision. Trauma to attached intraocular structures may be produced during discission techniques that stretch the membrane. The Sato discission technique produces membrane stabilization on a fixation needle. This allows controlled incision of the pupillary membrane at a right angle to the direction of the fibers without tension on surrounding structures. The Sato technique is not difficult, and surgical complications are minimal. Using this technique, adequate pupillary openings were produced in 62 of 65 eyes, with an average follow-up of 50 months. Postoperative visual acuity was 6/24 or better in 43 (74%) eyes. No long-term surgical complications were encountered.


Lens epithelium and radiation cataract. I. Preliminary studies. The migration of epithelial cells during fibergenesis in the lenses of young rats was determined by tritiated thymidine autoradiography. Cells initially labeled in the germinative zone appeared in the lens bow within seven days. Irradiation with either 600 or 2,400 rads of x-rays did not greatly alter the migration rate, but it did interfere with normal differentiation and proper fiber deposition, as manifested by a displacement posteriorly of the lens bow nuclei and an accumulation of abnormal nucleated fibers in the posterior part of the cortex. The presence of labeled cells in those regions prior to the onset of opacification is consistent with the possibility of direct epithelial cell involvement in radiation cataractogenesis.


Rapid eye movements in myasthenia gravis. I. Clinical observations. Rapid eye movements, having high velocity and low amplitude, are described in 11 patients with myasthenia gravis. These movements occur with various degrees of ophthalmoplegia. To distinguish them from the somewhat similar lid-twitch phenomenon, they are called quiver movements. We believed that their presence is pathognomonic of myasthenia and results from a differential involvement of the two myoneural mechanisms that are peculiar to the extraocular muscles.


Macroaneurysms of the retinal arteries.

Macroaneurysms of the retinal arteries. Six patients with spontaneous retinal and/or vitreous hemorrhages were found, on evaluation by fluorescein angiography, to have macroaneurysms involving the major retinal arteries. All showed evidence of other vascular disease. With absorption of the hemorrhages, five patients experienced appreciable improvement in vision. The aneurysms appeared to diminish in size as a result of fibrous changes within the arterial walls. In one patient, however, a second vitreous hemorrhage occurred several months later. The possibility of repeated hemorrhage suggests that more consideration should be given to treatment of these aneurysms.


Methodologic differences and measurement of cup-disc ratio: an epidemiologic assessment. A retrospective analysis was undertaken to estimate the effect on measurements of cup-disc ratio (CDR) that result from overall differences among examination methods used by experienced investigators. The findings suggest large inter-observer differences, that is, large differences in measurement attributable to differences in definitions and methods between one observer and another. Extreme caution is indicated before attaching wide clinical or investigative importance to a specific value of CDR. A value of CDR regarded as the dividing line between normalcy and suspicion by one observer may be a highly inappropriate cutoff for another observer. Similarly, if different observers record measurements on the same patient, it may be impossible to determine whether the cup of an individual patient changes with time. Interobserver differences also can cast doubt on conclusions drawn from the comparison of data collected by different investigators. There is a need for standardization of definitions and methods in such clinical or research situations.


Ectopia lentis et pupillae.

Ectopia lentis et pupillae. Two brothers had ectopia lentis et pupillae, an autosomal recessive disorder. Ascertainment of the brothers occurred through an unaffected sister, who sought genetic advice concerning possible risk for the disorder in her future children. Although the clinical features and the genetic aspects of ectopia lentis et pupillae are well documented in the older ophthalmologic literature, this entity has received relatively little attention recently in major reference texts.


Lysophosphatidyl choline and cataracts in uveitis. In aqueous humor from rabbits with uveitis or after anterior chamber paracentesis, the levels of lysophosphatidyl choline (LPC) were 10.2mug/ml and 14.7mug/ml, respectively. These LPC levels induce early cataractous changes in the rabbit lens in culture. Analysis of the fatty acid composition of LPC showed that saturated fatty acids were more predominant in secondary aqueous humor than in primary aqueous humor. In vitro, natural LPC induced more pronounced gains in sodium ions and water by the lens than similar concentrations of synthetic L-alpha-lysopalmitoyl phosphatidyl choline. In contrast to prostaglandin E, the levels of LPC in aqueous humor of rabbits with uveitis are cataractogenic. Thus, LPC or its precursors, rather than prostaglandins, are involved in the production of cataracts in uveitis.


Intracapsular plastic lens loop fixation in the rabbit. The fixation of two-loop intraocular plastic lenses has been studied in the laboratory. Twenty rabbit eyes underwent extracapsular lens extraction and placement of plastic lens loops within the capsular remnants. Placement was successful in 25 of 40 (62.5%) attempts. The placement of intracapsular lens loops was studied histologically, and the structural alterations were seen to be minimal. There was virtually no cellular response to the implantation of the plastic lenses, even in the areas of tissue contact.


Penetration of tobramycin sulfate in the aqueous humor of the rabbit. The intraocular penetration of tobramycin sulfate, a new aminoglycoside antibiotic, was evaluated in rabbits following subconjunctival injection. The mean tobramycin sulfate concentration in the aqueous humor 60 minutes after a single 5-mg dose was 5.5 mug/ml, as compared to a mean concentration of 6.7 mug/ml following a single 10-mg dose. These levels exceed the minimal inhibitory concentration (MIC) for most Pseudomonas species and a variety of other Gram-negative bacilli recovered from clinical infection. No anterior segment changes that may be attributed to the antibiotic could be demonstrated in the injected eye.


Pigmented iris angiography.

Pigmented iris angiography. A small volume of concentrated fluorescein was used in a technique of fluorescein angiography in rabbits. The procedure is not accompanied by the usual risks of general anesthesia in rabbits. Angiographic findings demonstrated that the pigmented rabbit iris vessel pattern is similar to that found in albino rabbits.


Effect of intraocular gas on intraocular pressure. The problems encountered in measuring intraocular pressure in eyes containing a compressible gas and the problem of determining the effect of changes in ambient atmospheric pressure on such eyes have been studied experimentally in enucleated human eyes and living rabbit eyes, and studied theoretically using the Friedenwald pressure-volume relationship, Boyle law, and the Goldmann equation of aqueous humor inflow and outflow. It has been concluded that high displacement tonometry, such as Schiötz tonometry will give false low measurements of intraocular pressure under these circumstances, and that there is no reliable way to correct these erroneous measurements other than to carry out tonometry with a low displacement instrument such as the Goldmann tonometer, the Perkins tonometer, or the Mackay-Marg tonometer. It was noted that large changes in intraocular pressure occur during rapid changes in ambient atmospheric pressure. It was concluded from theoretical considerations that persons with an eye containing 1 cu cm or more of a compressible gas should be advised to avoid air travel.


[Trauma and carcinoma--cause and corollary of osteomyelitis (author's transl)]. The fact that the hematogenic osteomyelitis can be cured, if a treatment with antibiotics is done early, confines the very difficult question about the correlation between trauma and hematogenous osteomyelitis to exceptional cases. Under certain conditions which have to be described in a more precise way, the trauma sometimes takes the form of an activating partial factor among the variety of causes of the hematogenous osteomyelitis, but is never the only producing cause. Fistulous chronic osteomyelitites are subject to a malignant degeneration at a specified frequency of up to 0.5%. Since an early diagnosis can seldom be made at an intra-osseus carcinoma localization, the demand for prophylactic measures is justified.


[Tissue regression as occupational disease. Character, causes, and assessment]. The most frequent of the so-called vocational diseases "Attrition of brachial joints after working with compressed-air-tools" and "Change of the miner's menisci" have only a loose causal connection with the occupations they are named for: By far the majority of such workers are not affected-even though they handle compressed-air-tools, or do the labor of miners all during their working life. This study explains, that the cause for these diseases is not to be sought in any external influences typical for these activities but rather in some negative tendency of patient's tissue--a definite morbidity towards tissue-regression. Patients are born with this inclination, with, therefore, is not insurable. The conditions for public accident incurance are fulfilled only if work with compressed-air-tools or labour of miners aggravates these negative tendencies. The somewhat indirect causal connection between diseases and occupations, do bring up certain problems and make it rather difficult, to judge these "tissue-regressions as vocational diseases".


[Tolerance of dimer-X for lumbosacral myelography (author's transl)]. This is a report about complications after myelography with Dimer-X. Three cases of transient and 1 case of permanent damage are described.