Neoplasms of the nasal passages and paranasal sinuses in domesticated animals as reported by 13 veterinary colleges. Three hundred cases of primary neoplasms involving the nasal cavity or paranasal sinuses were found among the reports of 12,300 microscopically confirmed neoplasms. The multispecies data were compiled from abstracts of medical records by 13 colleges of veterinary medicine in the United States and Canada from 1964 to 1973. Significant numbers of neoplasms were observed in dogs, horses, and cats. Intranasal neoplasms were more frequent than those of the paranasal sinuses in dogs and cats. Only cats had a sex difference in the occurrence of nasal neoplasms, with a male predilection. The frequency of neoplasms of the nasal cavity and paranasal sinuses increased with age in all species examined. A clear relationship could not be established between nose length and of intranasal neoplasms. Of the tumors, 80% were malignant in dogs, 68% in horses, and 91% in cats. Detailed review of medical records in a subset of 49 dogs with neoplasms of the nasal passage and paranasal sinuses revealed major clinical signs of nasal and ocular discharge, facial deformity, and stertorous breathing. Median duration of signs prior to diagnosis was 3 months and 95% of the dogs had been given treatment prior to definitive diagnosis. All 49 tumors were malignant; 27 were classified histologically as carcinomas and 22 were sarcomas. Nineteen dogs were treated, using surgery alone or in combination with radiation therapy. Median survival duration was 5 months (mean 6.7 mo).


Effects of temperature and time on the infectivity of Cryogenically preserved samples of Anaplasma marginale- infected erythrocytes. The effects of temperature (25 C) and time (2, 4, 6, 8, 12, 24, 48, 72, 96 hours and 5, 13, and 19 days) were determined on thawed samples of Anaplasma marginale-infected erythrocytes cryogenically preserved with dimethyl sulfoxide and frozen in liquid nitrogen. Inoculation into splenectomized calves indicated that infectivity was not destroyed by either time or temperature from 2 to 72 hours, but was destroyed at 96 hours. The incubation periods of the disease in inoculated splenectomized calves increased in proportion to the length of time the samples were held at 25C.


Mammalian toxicity of helenalin, the toxic principle of Helenium microcephalum CD (smallhead sneezeweed). Studies with smallhead sneezeweed (Helenium microcephalum DC) indicated that a sesquiterpene lactone, helenalin, is the only significant toxic constituent present. The oral median lethal dose of helenalin for 5 mammalian species was between 85 and 105 mg/kg.


Small airways in fibrosing alveolitis.

Small airways in fibrosing alveolitis. Pulmonary function, including lung elastic recoil, was measured in 9 subjects with fibrosing alveolitis. Closing volume and upstream conductance were studied to assess small airway function. Lung volumes, diffusing capacity, and transfer coefficient were decreased. Peak expiratory flow and the ratio of 1-sec forced expiratory volume to forced vital capacity were normal, whereas total lung resistance was low, suggesting that large airways were not narrowed. Lung elastic recoil was increased, but the changes could be accounted for by the loss of lung volume. Closing volume and closing capacity were increased when expressed as a percentage of vital capacity and total lung capacity, respectively; but again, this could be accounted for by the decrease in lung volume, because the absolute lung volume at which airway closure occurred was normal. Upstream conductance was not reduced. We conclude that there is no evidence of narrowing of functional small airways in ventilated parts of the lung. The mechanical findings are compatible with the patchy involvement seen pathologically in fibrosing alveolitis.


Computerized, noninvasive tests of lung function. A flexible approach using mass spectrometry. The design, operation, and some applications of a computerized pulmonary function testing system built around a mass spectrometer are described. The test sequence, performed in 10 to 20 min, includes spirometry, a single-breath N2 washout, and measurement of the diffusing capacity of the lung for CO. Secondary tests, an integral part of the sequence, include rebreathing estimates of lung volume and cardiac output, and a breath-by-breath analysis of over-all gas exchange. These secondary tests lead to computer modeling of a one-compartment lung closely matched to the subject's lungs. Differences between alveolar plateau slopes in the model and real lung provide information about the degree of ventilation-perfusion mismatch in the subject. It is expected that the combination of tests will be useful in the early detection of lung disease.


Ear oximetry: accuracy and practicability in the assessment of arterial oxygenation. The accuracy of three ear oximeters (Waters XP-350, Waters 0-1100, Hewlett-Packard 47201A) was evaluated on 52 subjects during acute progressive and steady-state hypoxia. Ear oximeter readings were compared with measured arterial saturation (SAO2) in arterial or "arterialized" capillary blood samples. Hewlett-Packard (HP) 47201A ear oximeter readings most closely approximated measured Sao2 (y=0.99x - 1.52, r=0.97), although both the HP 47201A and Waters 0-1100 oximeters provided similarly accurate estimates of SAO2 once the characteristics of the individual oximeters were known (standard error of estimate; 2.52 and 2.98 per cent SAO2, respectively). The HP 47201A ear oximeter was relatively insensitive to changes in ear-piece position and differences in skin pigmentation, and offered the added advantages of comfort, simplicity of operation, and stability of characteristics.


Respiratory response to tobacco dust exposure. Results of a study of the respiratory responses of 318 nonsmoking female workers to long-term tobacco dust exposure are reported. The mean total tobacco dust concentrations ranged from 0.9 to 27.5 mg per m3; the respirable fraction, from 0.3 to 3.6 mg per m3. The mean length of exposure to tobacco dust was 14.9 years; 24 per cent of the workers had been exposed to tobacco dust for 20 years or more. Comparatively low prevalences of chronic respiratory symptoms were found, and only the prevalences of chest tightness and wheezing were significantly higher among workers exposed to tobacco dust than those of the control group (P less than 0.01). Calculating the expected 1-sec forced expiratory volume and forced vital capacity values by means of multiple linear regression equations, developed on the basis of data obtained in the 210 control subjects, revealed no significant differences between the measured and expected ventilatory capacity values among any of the groups of the workers observed. In contrast to negative findings with regard to chronic respiratory effects, significant acute decreases in ventilatory capacity during the work shift were recorded. No dose-response relationship was found between the level of exposure and the acute decreases in ventilatory capacity.


Hemorrhagic hypotension and the lung: in vitro respiration. We examined the O2 consumption and respiratory quotient of lung slices from rats whose mean blood pressure was decreased to approximately 40 mm Hg for 1 hour by hemorrhage and from control rats that were handled in the same manner but were not bled. The in vitro O2 consumption of lung slices from the hypotensive rats was lower than the O2 consumption of slices from control rats; exogenous glucose did not alter these differences. In the absence of exogenous glucose, the (mean +/- SE) respiratory quotient of lungs from control rats was 0.75 +/- 0.01; from hypotensive rats 0.78 +/- 0.01 (P less than 0.05). Glucose increased the respiratory quotient of lung slices from control rats to 0.95 +/- 001 but increased the respiratory quotient of slices from hypotensive rats to only 0.86 +/- 0.01. We concluded that hemorrhagic hypotension decreases lung O2 consumption and alters substrate metabolism by the lung.


Isolation and characterization of two alpha1-protease inhibitors in rat serum. Two alpha1-protease inhibitors were identified in rat serum. On polyacrylamide gels, one (R-I) appeared at the leading edge of the albumin, the other (R-2) at the trailing edge. The two inhibitors have differing molecular weights, differing inhibitory spectra toward proteases, and are immunologically distinct. The assays for antiprotease activity were performed on whole human and rat sera and inhibitor-enriched fractions of rat serum that had been electrophoresed on polyacrylamide gels. The more rapidly migrating antiprotease of rat serum, R-I, inhibited trypsin, chymotrypsin, and elastase. The more slowly migrating antiprotease, R-2, inhibited both trypsin and chymotrypsin but possessed only weak anti-elastase activity. When a comparison was made between human alpha1-antitrypsin and the more rapidly migrating rat inhibitor, it could be seen that they have similar molecular weights, similar inhibitory spectra, and similar electrophoretic mobilities. The relevance of the study of the R-I inhibitor in the pathogenesis of experimental emphysema is emphasized.


Emphysema-like changes in the lungs of the blotchy mouse. The Blotchy allele is one of several mutations at the Mottled locus on the mouse X-chromosome. Affected males and heterozygous females within the several allelic groups possess varying degrees of connective tissue abnormalities similar to those found in copper-deficient and lathyritic animals, including aortic aneurysms and reduced skin tensile strength. There is evidence that defective inter- and intramolecular cross-links in collagen and elastin account for these abnormalities. The lung of the Blotchy mouse is also structurally and functionally abnormal. Hemizygous males have larger total lung volumes, markedly increased mean linear intercepts, and diminished internal alveolar surface area when compared to normal control animals. Light microsbopy and  scanning electron microscopy show abnormal architecture with enlargement of air spaces and effacement of alveolar septa. Static air and saline pressure-volume curves show that lungs of Blotchy mice have decreased elastic recoil and are significantly more compliant than normal. These abnormalities in the lung of the Blotchy mouse suggest that the defects of the connective tissue proteins described in skin and aorta also involve the lung. The Blotchy strain may be a useful model in which to investigate how abnormalities of connective tissue proteins influence pulmonary structure and function.


Regeneration of rat tracheal epithelium after mechanical injury. II. Restoration of surface integrity during the early hours after injury. Mechanical injury to ciliated and goblet cells of the rat tracheal epithelium results in sloughing of these cells. The basal cells of the pseudostratified epithelium remain. These cells, studied by scanning electron microscopy, transmission electron microscopy, and en face light microscopy after silver staining, are rounded and separated from one another for the first 2 hours after injury. They become flat and are apposed to each other by 4 hours after injury, but inter-cellular junctions are not uniformly present until 6 hours after injury. By that time, early evidence of stratification of cells is observed, and lanthanum hydroxide, as a colloidal tracer placed in the tracheal lumen, is excluded from the spaces between cells. The changes are indicative of rapid restoration of barrier function after mild injury to the respiratory tract lining as a first step in the reparatve process.


Scanning electron microscopy of the lungs of vitamin E-deficient rats exposed to a low concentration of ozone. The acute effects of a low concentration of ozone on the surface morphologic features of the conducting airways and alveoli were studied by scannging electron microscopy. Rats were exposed to approximately 0.3 ppm of ozone for 3 hours daily for as many as 16 consecutive days. Animals were killed at intervals of time, and their lungs were processed. Throughout the airways, cilia were seen to be swollen, showing hemispheric extrusions and considerable surface roughness. Groups of severely injured cilia had a tendency to adhere to each other. Small, round bodies were frequently noted, mainly in the large airways and the proximal bronchioles, in some areas thickly covering the airway epithelial surface. In addition, the luminal surfaces of the epithelium of the regions were often covered with a pseudomembrane. The surfaces of protruding nonciliated cells (Clara cells) showed many small swellings and discrete, round bodies. These changes were most marked in the terminal airways. The surfaces of alveolar ducts and alveolar walls showed scattered areas of cytoplasmic swelling and attachment of round bodies throughout the parenchyma. The findings described were more prominent in vitamin E-deficient rats than in rats fed a diet supplemented with vitamin E, suggesting an antioxidant effect of the vitamin.


Congenital lobar emphysema: long-term evaluation of surgically and conservatively treated children. The clinical conditions, roentgenographic findings, and pulmonary function tests of 6 children (mean age, 10.9 years) with surgically treated congenital lobar emphysema (group 1) were compared with those of 5 children (mean age, 10.3 years) with congenital lobar emphysema who had been treated conservatively, i.e., nonsurgically (group 2). At the time of this study, patients in both groups were asymptomatic. Patients in group 1 were surgically treated because of severe respiratory distress in the newborn period, with the exception of one patient, who was eupneic as a newborn and was not operated on until the age of 9 years. Patients in group 2 were eupneic or mildly distressed in the neonatal period and received only conservative treatment. Two patients in group 1 had occasional wheezing and labored breathing, but no patient in group 2 had recurrent respiratory distress. Roentgenographically, at the time of the study, patients in group 1 had generalized overinflation, whereas those in group 2 had only localized overinflation of the involved lobe and minimal compression of remaining lung tissue. Pulmonary function studies in both groups were not significantly different (P greater than 0.05). Both groups had reduced forced vital capacities, large trapped gas volumes, and reduced forced expiratory flows at low lung volumes. Reductions in forced vital capacity were proportional to the unventilated volumes of lung either excised because of congenital lobar emphysema (group 1) or chronically obstructed by congenital lobar emphysema (group 2). These studies suggest that lung growth was not different in these 2 groups and that asymptomatic or midly symptomatic patients do not benefit from surgical treatment.


Oxygen consumption by rat lung after in vivo hyperoxia. We studied the influence of 48 and 96 hours of in vivo hyperoxia (O2 greater than 98 per cent) on O2 consumption by rat lung slices. After 48 hours of hyperoxia, lung O2 consumption expressed per mg of deoxyribonucleic acid or per left lung decreased to approximately 70 per cent of that of lungs from rats exposed to compressed air. After 96 hours of hyperoxia, there was no difference in lung O2 consumption per mg of deoxyribonucleic acid between rats exposed to O2 and those exposed to air, but lung O2 consumption per left lung was higher in rats exposed to O2 than in those exposed to compressed air. Lung ribonucleic acid content and the ratio of ribonucleic acid to deoxyribonucleic acid were significantly increased after 96 hours of hyperoxia. We concluded that the rate of lung metabolism is altered after in vivo exposure to high PO2.


Effect of modification of the smoking habit on lung function. The effect of smoking cessation or modification on lung function was determined during a 48-week period. In a large number of the cigarette smokers, a disturbance of lung function was not revealed by conventional tests, such as the 1-sec forced expiratory volume; however, an abnormality was often demonstrable in tests that may reflect alterations in small airways, such as closing volume and Phase III of the single-breath expired N2 curve. There was no relation between the degree of abnormality of lung function and the presence of respiratory symptoms, but there appeared to be a relationship to lifetime smoking history, the heaviest smokers having the poorest function. Cessation, or more than 25 per cent decrease in the number of cigarettes smoked, was attened by improvement in the slope of Phase III of the N2 washout curve, closing volume, and closing capacity, as well as forced vital capacity, 1-sec forced expiratory volume, and peak flow. Resumption of smoking after cessation was attended by a deterioration in the slope of Phase III and closing capacity. The data suggest that the functional abnormalities in smokers are related to smoking and are at least partially reversible by cessation or significant modification of the smoking habit.


The effect of smoking cessation and modification on lung function. The purpose of this study was to obtain more information about the effect on lung function of stopping smoking or of modifying the smoking habit and to determine the time course of change. We followed a group of 75 cigarette smokers who attended a smoking cessation clinic in May 1973, using a respiratory symptom questionnaire, spirometry, closing volumes, and the slope of the alveolar plateau of the single-breath nitrogen test. Subjects were tested before stopping smoking and at 1, 3, 6, and 12 months after the initial testing. We found a significant (P less than 0.05) improvement in closing volume as a percentage of vital capacity and closing capacity as a percentage of total lung capacity at 6 and 12 months and in the slope of the alveolar plateau at 1, 6, and 12 months in those who stopped smoking. There was also a dramatic decrease in respiratory symptoms in those who stopped smoking, a moderate decrease in those who reduced their consumption by at least 25 per cent, and very little change in those who did not appreciably modify their smoking consumption.


Determination of lung volume by single- and multiple-breath nitrogen washout. In 10 normal volunteers, total lung capacity determined from a single-breath N2 washout was not significantly different from that determined by body plethysmography. However, in patients who underwent clinical pulmonary function tests, total lung capacity was substantially underestimated by the single-breath N2 washout, compared with that determined by either body plethysmography or the 7-min open-circuit N2 washout method. The single-breath N2 washout underestimated total lung capcity in patients who had a normal slope of Phase III, and the error was even greater in patients who had steeper Phase III slopes or low maximal mid-expiratory flow values. Total lung capacity determined by 5 vital capacity breath N2 washout method was comparable to that determined by the 7-min N2 washout method, provided that expired N2 did not exceed 10 per cent during the fifth vital capcity maneuver. By extending the washout beyond 5 vital capacity maneuvers when necessary to achieve a peak expired N2 of less than 10 per cent, a mean total lung capacity within 1 per cent of that determined by the 7-min washout method was obtained. The multiple vital capacity maneuver was well tolerated by patients and saved considerable time.


The morphologic features of the bronchi, bronchioles, and alveoli in chronic airway obstruction: a clinicopathologic study. A 6-year semiquantitative clinicopathologic study revealed that among 196 men and 46 women 40 or more years of age at death, the severity of destructive emphysema was overwhelmingly the most important morphologic correlate of the clinical state of chronic airway obstruction. The pathogenic mechanisms whereby emphysema may lead to airway obstruction are probably multifactorial, but our data are consistent with a growing consensus that loss of small airway support by surrounding lung tissue in emphysema may cause kinking, tortuosity, and collapse of the airways, with subsequent increased airflow resistance and clinical obstruction. Pathologic changes (inflammation, fibrosis, increased goblet cells, and mucous gland enlargement) in large or small airways in the absence of much emphysema were very seldom associated with significant chronic airway obstruction, and correlated rather poorly with chronic airway obstruction, regardless of severity of emphysema. A subjective method of evaluating mucous gland enlargement in the large airways was consistently better than the Reid Index in correlations with clinical and anatomic abnormalities, presumably because it took all glands into consideration. The clinical features of subjects with severe centrilobular versus severe panlobular emphysema were essentially the same. "Blue bloater" and "pink puffer" clinical types of chronic airway obstruction continued to reveal differences in airway pathologic features, but no longer revealed a major difference in the severity of emphysema at the time of death. Presumably this was due, at least partially, to improved treatment, longer survival, and fusion into a similar end-stage. The total exposure to cigarette smoke was quantitatively related to clinical chronic airway obstruction and to both alveolar and airway pathologic features.


Probable familial congenital bronchiectasis due to cartilage deficiency (Williams-Campbell syndrome). Two siblings in whom respiratory symptoms developed immediately after birth subsequently were found to have bronchiectasis with strikingly similar distribution of lesions (mainly lower lobes). Inspiratory and expiratory bronchograms performed on one of the siblings demonstrated marked ballooning and collapse of proximal bronchi during tidal breathing. The clinical courses and roentgenographic findings, in the absence of other underlying abnormalities, suggest that the basic disease process was the absence of bronchial cartilage (Williams-Campbell syndrome). This would be the first reported familial occurrence of this syndrome. The familial pattern and the neonatal onset of symptoms support the theory of a congenital basis for this variety of bronchiectasis.


Diaphragmatic changes in emphysema.

Diaphragmatic changes in emphysema. The diaphragms and lungs of 95 men were quantitatively examined at autopsy, and the following observations were made. The area of the whole diaphragm had a significant inverse correlation (r= -0.412, P less than 0.001) with the percentage of the lung occupied by emphysematous lesions. Most of the reduction in the area of the whole diaphragm associated with advanced emphysema occured in the muscular portion; in contrast, the thickness of the diaphragm was not affected by percentage of the lung occupied by emphysematous lesions. Neither body height nor postmortem lung volume had as close a relation to area of the whole diaphragm as did percentage of the lung occupied by emphysematous lesions. The conclusion drawn from these observations is that the diaphragm area reduction associated with emphysema is related to altered thoracic shape, probably diaphragm flattening in particular, and is better described as contracture than as atrophy. It is speculated that these morphologic changes contribute to the altered diaphragmatic function characteristic of chronic obstructive pulmonary disease, and thereby to the ventilatory abnormalities seen in patients with this disorder.


Pulmonary effects of chronic exposure to airborne cadmium. Workers chronically exposed to high concentrations of airborne cadmium showed a significantly decreased forced vital capacity relative to a low-exposure group and had Po2 values in the normal range, but at the extreme low end. They had no significant decrease in 1-sec forced expiratory volume or maximal mid-expiratory flow. Chest roentgenograms showed mild or moderate interstitial fibrosis in 29 per cent of the group exposed to cadmium. Collectively, these results suggest a mild fibrotic reaction associated with exposure to cadmium. A dose-response association was observed between forced vital capacity, expressed as per cent predicted, and both average urinary cadmium concentration (P less than 0.003; r=-0.53) and maximal urinary cadmium concentration (P less than 0.005; r=-0.51). Further, a dose-response relationship was found between the forced vital capacity and months of work in cadmium fume areas, but not for months of exposure to cadmium sulfate aerosol.


Detection of precipitating antibodies to Histoplasma capsulatum by counterimmunoelectrophoresis. The technique of counterimmunoelectrophoresis was evaluated for its usefulness in the detection of precipitating antibodies to Histoplasma capsulatum, designated h and m precipitin bands. Forty-four patients with active histoplasmosis had either m bands or both h and m bands. The h precipitin band occurred primarily in patients with disseminated disease, chronic pulmonary disease, or mediastinal lymphadenopathy of several months' duration; with resolution of the infection, this antibody disappeared. The m band appeared earlier in the course of histoplasmosis and persisted for months to years after resolution of the infection. Antibodies detected by counterimmunoeelectrophoresis were in the immunoglobin G class and were more specific for histoplasmosis than those detected by the complement fixation test. Only one false positive h band occurred in a total of 81 sera tested (specimens from 24 healthy control subjects and 57 patients with other diseases). Counterimmunoelectrophoresis was both more sensitive and quicker than immunodiffusion at detecting h and m antibodies. Combining this assay with standard complement fixation tests and fungal culture methods should lead to the accurate, rapid diagnosis of histoplasmosis.


Lipids found in pulmonary lavage of patients with alveolar proteinosis and in rabbit lung lamellar organelles. Lipids from the insoluble material obtained by pulmonary lavage of 6 patients with alveolar proteinosis and from lamellar organelles of normal rabbit lungs were isolated and characterized. In both types of samples, dipalmitoylphosphatidylcholine was the predominant lipid. Phosphatidylethanolamine, phosphatidylglycerol, lysophosphatidylglycerol, and 2 glycolipids, GM3  and GL1 were also present in both types of preparations. Sphingomyelin, lysophosphatidylcholine, lysophosphatidylethanolamine, phosphatidyl-N, N-dimethylethanolamine, phosphatidylserine, and lyso(bis)phosphatidic acid were found in the sedimented lavage material from humans but were not detected in lamellar organelles from rabbits. Significant quantities of neutral lipids were present in the lavage material, but only trace amounts, mainly as cholesterol and triglycerides, were detected in lamellar organelles. Phosphatidylcholine and the 2 glycolipids  contained mostly saturated fatty acids and essentially no polyunsaturated fatty acids. Sphingomyelin, lysophosphatidycholine, and phosphatidyl-N, N-dimethylethanolamine, found only in the lavage, were also highly saturated. In addition to the fact that several phospholipids found in the lavage were not present in lamellar organelles, another striking difference between the lipids from these 2 sources was that phosphatidylglycerol of lamellar organelles contained predominantly palmitic acid, whereas the phosphatidylglycerol obtained by lavage of humans contained large amounts of stearic and oleic acids.


Infectiousness of laryngeal tuberculosis. Two patients with laryngeal tuberculosis in the absence of extensive pulmonary tuberculosis are presented. In both, tuberculin testing of household members failed to show infectiousness of their disease. This contradicts the commonly held view that laryngeal tuberculosis is invariably highly infectious. The extent and activity of pulmonary disease probably determines the infectiousness of patients with laryngeal tuberculosis rather than the laryngeal lesion per se.


Cellular and humoral bronchopulmonary immune response of rabbits immunized with thermophilic actinomyces antigen. The immunologic events involved in the pathogenesis of human hypersensitivity pneumonitis are poorly understood. To delineate better the cellular and humoral bronchopulmonary response to host challenge with an important agent for hypersensitivity pneumonitis, an animal model was developed. Rabbits intratracheally inoculated with Micropolyspora faeni antigen developed histologic lesions resembling hypersensitivity pneumonitis in man, characterized by a mononuclear cell interstitial reaction and a marked increase in the number of intra-alveolar cells. This reaction was intense 8 days after immunization and progressively decreased in intensity, with complete resolution occurring, in some instances, by 3 weeks. The increased intra-alveolar cells were predominantly macrophages, but soon after immunization, greater numbers of lymphocytes and granulocytes were present. Associated with the intra-alveolar macrophage response was the appearance of "activated" macrophages, based on increased glucose oxidation and ultrastructural appearance. The immunized rabbits demonstrated Arthus-type skin reactions, as well as delayed hypersensitivity skin reactions after intradermal injection of M. faeni antigen. Alveolar macrophage migration was significantly inhibited in immunized rabbits in the presence of M. faeni antigen, suggesting that specifically sensitized lymphocytes were present in the free bronchoalveolar cell population. Intratracheal inoculation with M. faeni resulted in the production of anti-M. faeni-precipitating antibodies in the sera of all animals and in bronchoalveolar secretions in 15 of 16 inoculated rabbits. The concentrations of IgG and IgA in lung-wash fluid were significantly greater in immunized animals. In the immunized rabbits, the mononuclear cell response, positive M. faeni-induced direct migration inhibition factor assays, and delayed skin reactivity strongly suggested the presence of a delayed hypersensitivity component in disease pathogenesis. The presence of precipitating antibody and the increased concentrations of immunoglobulins were consistent with stimulation of the humoral immune system; however, the role of humoral mechanisms in the pathogenesis of the pulmonary lesions is less certain than that of delayed hypersensitivity.


Oxygen tension and the selective tropism of K-virus for mouse pulmonary endothelium. This study focused on the unique nature of K-virus pneumonitis in suckling mice. This process, rather than being a conventional pneumonitis, is characterized by viral replication and cytopathic effects restricted exclusively to pulmonary endothelium. The selective viral attack on this air-blood interface suggests that K-virus is an endotheliotrope that requires a richly oxygenated intracellular milieu for replication. This possibility has been explored by studies of the course of K-virus infection in suckling mice under conditions of normal (21 per cent), increased (40 per cent), and decreased (10 per cent) 02 content of inspired air. The absence of critical modulating influences of these varied environmental conditions rules out a significant role of tissue 02 concentrations as determinants of the selective tropism of K-virus.


Emphysema and its relation to age.

Emphysema and its relation to age. To establish whether a correlation existed between emphysema and age, 24 lungs were used to measure the alveolar membrane fenestrations; the average area of 100 fenestrae was then plotted against age. Eighteen of these lungs were from patients 17 to 86 years of age with no history of respiratory ailments, whereas 6 lungs were from patients in whom an antemortem diagnosis of emphysema had been made. A significant, positive correlation between age and the area of fenestrae (t=2.4;p greater than 0.05) was found in the group of 18 lungs from patients with no respiratory ailements. The same could not be said categorically about the lungs from the emphysematous group, because the number of lungs examined was too small. We postulate that the pores of Kohn are part of the degenerating emphysematous process and are the first stage in the formation of fenestrae. A possible mechanism for the formation of fenestrae and their classification into 4 grades is presented.


An intravenous radionuclide method to evaluate hypoxemia caused by abnormal alveolar vessels. Limitation of conventional techniques. Using conventional concepts, it is possible that a single pathologic entity, pulmonary telangiectases, can produce hypoxia by 3 physiologic mechanisms; shunt, diffusion defect, and ventilation-perfusion abnormalities. The estimation of shunt or shunt-like effect is traditionally calculated by measuring the Po2 of arterial blood during the breathing of 100 per cent 02. This method, however, did not determine blood flow through large alveolar vessels in a patient with familial hemorrhagic telangiectasis who was severely hypoxemic while breathing air. This case served to test the concept that blood flowing through large vessels in the airspaces may be hypoxemic when the patient breathes air, but not 02. Blood flow through these vessles can be estimated by use of radionuclide lung perfusion techniques and estimation of the quantity of radioactive particles that pass through an abnormal pulmonary vascular bed and lodge in kidney and brain. Conventional approaches to estimating blood flow through these fistulas underestimated their effect.


Transbronchial biopsy via flexible fiberoptic bronchoscope; results in 164 patients. The diagnostic accuracy and complication rate of transbronchial forceps lung biopsy combined with bronchial brushing were analyzed in 164 consecutive patients, of whom 95 had nonmalignant disease and 51 had malignant disease. Eighteen patients with abnormal chest radiographs had normal transbronchial forceps lung biopsies and no established diagnosis. Satisfactory specimens were obtained in 153 patients (93 per cent), with diagnositc accuracies of 62, 64, and 67 per cent, respectively, in infectious, interstitial, and malignant lung disease. The over-all diagnostic accuracy was 57 per cent. Seven patients were diagnosed as having metastatic carcinoma to the lung by transbronchial forceps lung biopsy, but brush biopsy was psoitive in only 3. Of the 23 patients with primary lung carcinoma diagnosed by transbronchial forceps lung biopsy, 21 had positive brush biopsies. An additional 3 patients with bronchogenic carcinoma, however, were diagnosed only by brush biopsy. Fluoroscopy was essential for accurate positioning of the biopsy instrument. Increased risk factors were present in 83 patients (51 per cent), among whom the immunosuppressed group presented special problems. Significant bleeding in 15 patients (9 per cent) was controlled by conservative management. Pneumothorax occurred in 7 patients (4 per cent). There were no deaths. Transbronchial forceps lung biopsy in experienced hands is safe and well tolerated. The physician, nevertheless, must be prepared to handle major complications, especially bleeding. The procedure has a resonable diagnostic yield in high-risk patients who have a variety of lung lesions.


Arteriovenous fistulas for hemodialysis: experience with 100 cases. One hundred radial-cephalic fistulas were surgically created for hemodialysis between April 1970 and September 1973. A side-to-end anastomosis was constructed in 86 per cent of cases. Overall patency interval was 13 months. Factors responsible for shunt failure are outlined. Blood vessel quality and surgical technique are the most important factors in achieving a low failure rate. Use of the fistula for early hemodialysis has not been associated with complications and is advocated.


Diagnosis and management of pancreatic trauma. The diagnosis and management of 76 patients with pancreatic trauma is reviewed. There was an overall mortality rate of 5 per cent. A preoperative serum amylase determination was a valuable parameter when assessing blunt trauma. Operative management required debridement and external drainage in approximately three-fourths of all injuries. Pancreatic resection was reserved for ductal disruption. Interruption of ductal integrity accounted for 47 per cent of all complications. Only one-third required reoperative therapy. Associated major vascular injuries accounted for all deaths.


Diagnosis and management of hyperparathyroidism. The surgical experience with hyperparathyroidism at this institutition of 32 cases since January 1969, has been presented. The age range, sex ratio, associated disease and location of adenomas follows previously reported patterns. Analysis of various preoperative laboratory data confirm that no single test consistently can establish the diagnosis of hyperparathyroidism. At exploration, all glands should be identified and all adenomas removed. Subtotal parathyroidectomy consisting of excision of 3 3/4 glands should be performed for hyperplasia.


Stercoraceous ulcer.

Stercoraceous ulcer. Seven cases of stercoraceous ulcer are presented and discussed; six occurred in the colon and one in the terminal ileum. The six colon ulcers perforated; the ulceration of the ileum presented as obstruction without perforation. The mean age was 48. Five patients had chronic constipation, and alkali and clay ingestion were implicated. There was an interesting lack of a marked febrile and leukemoid response. Three patients survived following exteriorization or resection.


Chronic torsion of the spleen.

Chronic torsion of the spleen. Wandering spleen may result from congenital failure of splenic attachments or acquired laxity of attachments due to stretching. The wandering spleen is quite vulnerable to the complication of torsion, which is seen most often as an acute abdominal emergency due to splenic infarction. A more unusual variant is chronic torsion which causes intermittent mild to moderate abdominal pain, gastrointestinal disturbances and, in one case, hypersplenism. A mass has been present in most cases and may be anywhere in the abdomen or pelvis. Splenectomy should be performed for all cases of wandering spleen with or without torsion.


Gunshot wounds of the suprarenal abdominal aorta. Four cases of gunshot wounds to the suprarenal abdominal aorta are described. All required prosthetic graft replacement including one or more visceral arterial branches. Two patients survived. Factors important in survival were rapid transportation permitting early resuscitation and retroperitoneal tamponade which delayed exsanguination and permitted stabilization with systematic management. The major problem in management of gunshot wounds of the suprarenal abdominal aorta is limitation of visceral ischemia, particularly hepatic and renal. Special adjuncts such as local renal hypothermia, as used in these cases, or bypass techniques are necessary and should be available before exploration of a periaortic hematoma due to gunshot wound in this area.


Volvulus of the sigmoid colon.

Volvulus of the sigmoid colon. A 30-year experience with sigmoid volvulus from the City of Memphis Hospital is presented with 121 cases. Differentiating viable from gangrenous sigmoid volvulus is difficult from history, physical examination, or laboratory data and one must rely on sigmoidoscopy. Sigmoidoscopy with insertion of a colon tube is the initial management with operative detorsion only if sigmoidoscopy fails. Elective sigmoid resection is advocated in view of the high recurrence rate. In gangrenous sigmoid volvulus, a Hartmann's procedure is preferred. There is a significant rate of "recurrent sigmoid volvulus" after elective resection.


Colonoscopic polypectomy.

Colonoscopic polypectomy. The colonoscopic management of 86 patients with polypoid lesions of bleeding from the colon of intermittent nature is discussed. There were 145 polyps found in 85 of these patients. Adenomatous polyps occurring in the sigmoid colon above the reach of the standard sigmoidoscope was the most common finding and pathological diagnosis. Adenocarcinoma of the colon occurred in two patients and invasive carcinoma of a polyp was found in three other patients. Five other patients had polyps that demonstrated a carcinoma in situ. The definitive treatment of these complicated polyps is outlined. The importance of barium enema examination on follow-up of polyp and carcinoma patients and on patients with polyps found at standard sigmoidoscopy is stressed. The possibility of colonoscopic follow-up in lieu of colectomy and ileoproctostomy is suggested for patients with multiple polyps of the colon who do not belong to the familial polyposis group.


Duplication of the alimentary tract.

Duplication of the alimentary tract. Duplications of the intestinal tract as can be seen from the embryologic and anatomic descriptions are varied and frequently complex. The great variety of presentation and pathology encountered requires almost individual treatment for each case. Certainly total surgical excision, or at the very least, good complete internal drainage should be carried out in these cases. Correct therapy should afford relief of the patients's symptoms and prevent future complications.


Benign biliary tract disease in the patient over 80. Cases of 50 patients over 80 years old with advanced benign biliary tract disease are reviewed from the standpoint of morbidity and mortality. Based on the information obtained from this review, recomendations are made as to the course of therapy.


Neonatal small left colon syndrome: report of two cases. Two cases of neonatal small left colon syndrome are described. This syndrome usually is seen as bowel obstruction in the neonate with characteristic roentgenographic features resembling those of Hirschsprung's disease. In view of the usual improvement after contrast enema, a trial of conservative management seems warranted. Rectal biopsy may be the only way to differentiate those patients who do not improve from those with Hirschsprung's disease.


Surgical treatment of late esophageal perforations. The salvage of patients with late esophageal perforations is a formidable surgical undertaking. The basic objectives of surgical therapy should be: prompt debridement and control of sepsis by establishing an adequate, controlled route of decompression drainage, salvage of all viable and functional esophagus (except in massive disruptions with circumferential loss), adequate support of life control systems, and establishment of an appropriate alternate route for supportive alimentation. The method of treatment used in the group of patients reported here satisfies all these objectives. Our experience justifies further consideration of this technique in dealing with this catastrophic illness.


The vagus.

The vagus. The surgical physiology of the vagus is reviewed with respect to vagotomy in the treatment of duodenal ulcer. All types of vagotomy (truncal, selective gastric, or proximal gastric) produce similar reduction in acid secretion and comparable elevation in serum gastrin. The evidence is mounting that the vagus may have opposing influences on gastrin release: stimulation and inhibition. Division of only the extragastric vagal branches leads to withdrawal of an inhibitory mechanism rendering the denervated stomach more sensitive to the action of gastrin. The loss of this vagally controlled inhibitory mechanism, rather than more meticulous dissection, may explain the higher incidence of more complete vagotomies in selective than in truncal vagotomy. Proximal gastric vagotomy may be the ideal elective operation yet devised for duodenal ulcer. It does, however, cause elevation in serum gastrin and more than 90 per cent of patients after this operation will have positive insulin test in two to four years. This is higher than the positivity seen with truncal vagotomy. Results of controlled trials are needed before this operation becomes fully established.


Prognostic implications of bronchogenic carcinoma proven by bronchoscopic biopsy. A total of 104 cases of bronchoscopically biopsy proven bronchogenic carcinoma are reviewed. Twenty-seven of 39 patients with operable lesions underwent pulmonary resection. There are seven patients with squamous cell tumors who are long-term, cancer-free survivors. The operative mortality was low at 2.3 per cent. A positive bronchoscopic biopsy should not be considered a contraindication for exploration, and an aggressive approach for squamous cell lesions seems justified.


Surgical treatment for ventricular aneurysm. The results of 110 patients with ventricular aneurysm treated surgically are discussed. The overall mortality in this group was 11.8 per cent. Since the use of coronary bypass operation and the intra-aortic balloon pump, the mortality has been significantly reduced.


Femoropopliteal versus femorotibial bypass grafting for lower extremity revascularization. Thirty-nine femoropopliteal revascularization procedures were compared with 35 femorotibial revascularization and one brachioradial revascularization over a follow-up period of six months to six years. Preoperative study, operative technique, results and complications are described. Living patency is compared with closure rates. The living patency rates are 49 per cent and 51 per bent for the femoropopliteal and femorotibial group. The complication rate was higher in the femorotibial group by four times (37% compared to 10%). Four reoperations were done because of progression of the patient's disease in the femorotibial group. Femorotibial revascularization is at least as effective as femoropopliteal revascularization, and produces a comparable live patency record, but with a higher incidence of postoperative complications.


Aneurysmal rupture following resection of abdominal malignancy. Four cases of ruptured abdominal aortic aneurysms as a postoperative complication are reported. This represents a 24 per cent mortality for elective operation in patients with known abdominal aortic aneurysm. Three cases followed resection of abdominal malignancy. The possibility exists that subtle trauma during operative manipulation may have heightened the risk of rupture. The risk to life from large abdominal aortic aneurysms (more than 6 cm) exceeds the risk of most malignancies. Abdominal aortic aneurysm should be resected first when co-incidental to a malignancy, unless the malignancy is complicated by hemorrhage, obstruction or perforation.


Ruptured abdominal aortic aneurysms.

Ruptured abdominal aortic aneurysms. The problems, results and treatment suggestions in regard to ruptured abdominal aortic aneurysms are discussed.


[Duchenne muscular dystrophy. Presentation of 25 cases and literature review (author's transl)]. Twenty-five patients with Duchenne muscular dystrophy, aged between 18 months and 13 years, whose fundamental clinical symptomatology, can be united within three different age groups are presented. These symptoms are in order of frequency: difficulties in walking, general muscular debility and total functional incapacity. Reference to biochemical studies and to studies of healthy carrier mothers, as well as, to electrical, cardiological and phychical studies are made. No differences, with regard to observations made by other authors, except in the C.I. findings on the different mental tests that we carried out are found. Approximately 50% are found to be mentally deficient. Other published theories are quoted herein.


[Neonatal listeriosis. Presentation of nine cases (author's transl)]. Nine cases of neonatal listeriosis observed in 1973 and 1974 are presented. Diagnosis was established during life in eight cases by positivity of bacteriological cultures. Given the high incidence of listeria sepsis and the important mortality, it is necessary to establish an early diagnosis, an immediate antibiotic therapy and provide intensive care in an special unit.


[Traumatic duodenal hematoma (author's transl)]. Two cases of duodenal hematoma secondary to abdominal trauma in children are reported. The latent periods between trauma and the onset of symptoms were two and fifteen days. X-ray studies were conclusive for diagnosis. Pancreatic signs were mild in one case. Both cases were treated surgically, draining the fluid collection extramucosally. The authors advise surgical treatment whenever associated lesions need to be ruled out and when obstruction persists after the first days.


[Chromosome delection point in "cri du chat" syndrome (author's transl)]. Chromosomal identification by a G technique done in three patients with delection of the distal portion of short arms of chromosome 5; led to the consideration of the possibility that the segment responsible of the "cri du chat" syndrome is on the proximal portion of the band 5 p15.


[Congenital syphilis (author's transl)]. Nine cases of congenital syphilis were observed by the authors during the last three years. 120,000 records were collected during this period. Several remarks are made on to-days views on etiology; clinical features and serologic diagnostic tests currently in use, as well as about treatment.


[Foreign bodies in digestive tract (author's transl)]. One hundred and seventy three cases of ingestion of foreign bodies by children are reported. Their nature and evolution inside the organism is discussed. Laparotomy was required in only one case.


[HGH response to dihydroxyphenylalanine (L-dopa) (author's transl)]. L-dopa, administered at dose levels of 250 mg., was used to assess HGH release in 36 children. In five cases of hypopituitary dwarfs no response was obtained and in the remaining 31 cases affected by short stature not of endocrine origin, the highest peak was produced 30' after the test (12.71 +/- 11.61 ng/ml; p less than 0.0005). Significant responses were also obtained at 60' (11.81 +/- 10.47 ng/ml; p less than 0.0005), 90' (7.25 +/- 7.49 ng/ml; p less than 0.0005) and 120' (4.8 +/- 4.86 ng/ml; p less than 0.005).


The intravenous furosemide test: a simple way to evaluate renin responsiveness. To identify patients with low-renin hypertension, we measured plasma renin activity after the administration of 40 mg of furosemide intravenously and 30 minutes of upright posture in 127 normotensive subjects and 363 patients with essential hypertension. Plasma renin activity 30 minutes after intravenous furosemide was found to be closely correlated to the level found after either 2 or 4 h of standing or 3 days of a low-salt diet plus 2 h of upright posture. Renin responsiveness was significantly lower in hypertensive patients, blacks, and women, compared with normotensive subjects, whites, and men respectively. The level of plasma renin activity in most normal white subjects was greater than 1.0 ng/ml - h and in most normal blacks was greater than 0.5 ng/ml - h. It was below those levels in 23% of white hypertensive and 25.2% of black hypertensive patients respectively. The mean level of plasma renin activity fell with increasing age of hypertensive patients. This procedure is recommended as a safe, easy, and reliable test for assessing renin responsiveness and identifying the low-renin state.


Improved outcomes in hypertension after physician tutorials. A controlled trial. Physicians working at the General Medical Clinic of the Johns Hopkins Hospital entered into tutorials to improve their effectiveness as managers and educators of patients with essential hypertension. After exposure to a single teaching session, tutored physicians allocated a greater percent of clinic-visit time to patient teaching than did control physicians, achieving increased patient knowledge and more appropriate patient beliefs regarding hypertension and its therapy. Patients of tutored physicians were more compliant with drug regimens and had better control of blood pressure than patients of untutored physicians. The personal physician, if he is provided with strategies for identifying the noncompliant patient and for intervening in that behavior, can apply a stimulus to his patients that results in improved compliance and better control of hypertension.


[Budd-Chiari syndrome in childhood by hipoplasia of suprahepatic veins. Clinical and pathological study of a case (author's transl)]. A case of Budd-Chiari syndrome with hypoplasia of suprahepatic veins is reported. A bibliographic review is made. Etiologic and anatomic factors are analyzed. Its clinical, analytic, pathological and embryologic findings are compared with those of other authors. The rarity of this case, for the age of presentation as much as for its etiology is pointed out.


Ionized and total serum calcium and parathyroid hormone in hyperthyroidism. Total and ionized calcium concentrations as well as parathyroid hormone levels were measured in a group of hyperthyroid persons. Ionized and total calcium levels were elevated in 21 of 45 (47%) and in 12 of 45 (27%) thyrotoxic patients, respectively. Mean ionized and total calcium levels were higher in these 45 patients than in normal persons. Using two different radioimmunoassay systems for a total of 44 determinations, mean parathyroid hormone levels were lower in thyrotoxic patients than in subjects with proved hyperparathyroidism. These data suggest that [1] elevations of both ionized and total calcium concentrations occur frequently in thyrotoxic patients; [2] ionized calcium concentrations may be elevated in a higher percentage of hyperthyroid subjects than are total calcium concentrations; and [3] the hypercalcemia associated with thyrotoxicosis is not associated with elevated parathyroid hormone levels.


Thyroid dysfunction in uremia: evidence for thyroid and hypophyseal abnormalities. Disturbances in thyroid function and a high prevalence of goiter develop in patients on chronic hemodialysis. This study shows that in patients on dialysis, mean serum thyroxine and triiodothyronine levels are lower than normal. Patients with chronic renal failure not on dialysis, have mean serum thyroxine levels similar to normal subjects and low mean serum triiodothyronine levels. However, both serum thyroxine and triiodothyronine concentrations decrease as the renal failure worsens. In addition, both groups of patients with renal failure have a decreased serum thyroxine response to oxogenous thyrotrophin and a diminished serum thyrotrophin response to thyrotrophin-releasing hormone. These data suggest the presence of an intrathyroidal and an hypophyseal defect in uremic patients. Although serum iodide concentrations are elevated, there is no correlation between the level of serum iodide and the degree of renal failure. Therefore, we have no direct evidence that iodide excess is responsible for the abnormalities observed.


[Iron deficiency anemia in childhood. A case with associated deficiency of folic acid (author's transl)]. The case of a six year and ten months old girl with an iron deficiency anemia of long duration is reported. The lack of iron was associated with folic acid deficiency, which disguished the hematologic pattern, presenting a normocromic and aniso-poiquilocytic anemia. Long duration of iron deficiency allowed for evaluation of the iron deficiency effects on weight and height growth which were diminished as well as on the functioning and morphology of the gastrointestinal system, showing malabsorption syndrome which improve with iron supply.


[Kniest's disease. Metatropic dwarfism (author's transl)]. A new case of Kniest's Disease (bone dysplasia, retinal detachment and deafness), the first one in Spanish medical literature, is reported. Clinical and radiological considerations are made. Finally genetic theories of transmision and diagnosis of the disease are discussed.


Renal failure after open heart surgery.

Renal failure after open heart surgery. One hundred fifty of 490 patients undergoing open heart surgery had renal failure attributable to cardiopulmonary bypass. In 69, serum creatinine concentrations did not exceed 2 mg/dl and returned to normal by the fourth postoperative day. In 60 patients, serum creatinine attained levels between 2 and 5 mg/dl, oliguria did not develop, and recovery of renal function occurred within 4 to 37 days. Serum creatinine increased to levels exceeding 5 mg/dl in 21 patients, 11 of whom were oliguric. Despite dialysis, 14 of these patients died from cardiac causes or sepsis. Prolonged cardiopulmonary bypass time, hypotension, oliguria, low output syndrome, and hemoglobinemia during open heart surgery correlated with the development of renal failure postoperatively. Although severe renal failure was an uncommon complication after open heart surgery, its occurrence carried a grave prognosis.


Intravascular coagulation with use of human prothrombin complex concentrates. Prothrombin complex concentrates are used in the treatment of the congenital bleeding disorders associated with Factors II, VII, IX, and X deficiencies. They have also been extensively used to treat acquired coagulation abnormalities secondary to vitamin K deficiency, warfarin ingestion, and various types of liver disease. The reported complications of prothrombin complex concentrates administration include hepatitis, anaphylaxis, and thrombosis. This paper documents the development of disseminated intravascular coagulation in association with the administration of prothrombin complex concentrates to patients with liver disease.


Angina-like syndrome with diazoxide therapy for hypertensive crisis. In 14 patients with hypertensive crisis treated with diazoxide, close monitoring of blood pressure, heart rate, and symptoms was performed. Standard 12-lead electrocardiograms were recorded before and after diazoxide. All patients showed a significant fall in blood pressure after drug administration. Seven patients (50%) showed significant ST-T changes after diazoxide. Six patients (43%) developed substernal discomfort demonstrated by substernal pain of tightness. Five patients (35%) had both chest discomfort and ST-T changes. One of these patients with substernal pain and ST elevation had evidence of acute myocardial infarction with serial enzyme studies. In the patients with significant ST-T changes, the average fall in blood pressure was significantly greater than the average fall in blood pressure in the patients without significant ST-T changes. These findings suggest that both ST-T changes and substernal discomfort were due to myocardial ischemia secondary to a sudden severe drop in blood pressure.


Prevention of lower extremity venous thrombosis by early mobilization. Confirmation in patients with acute myocardial infarction by 125I-fibrinogen uptake and venography. To determine the effects of early ambulation on peripheral venous thrombosis in the coronary care unit, 29 patients with acute myocardial infarction had daily 125I-fibrinogen point counting of both legs using a standard portable technique in the first 3 to 7 days after admission. Twenty-one patients underwent early ambulation during the initial 3 days, while 8 remained at complete bed rest for 5 days. Only 2 of 21 early ambulated patients had positive fibrinogen point counts, in contrast to 5 of 8 nonambulated patients (P less than 0.01). With heart failure, only 2 of 9 ambulated patients had positive point counts, compared with 4 of 5 nonambulated patients (P less than 0.05). In 16 patients undergoing venography, point counts were confirmed in 6 positive and 10 negative findings. These results show that the high frequency of peripheral venous thrombosis in immobilized acute myocardial infarction patients, particularly those with heart failure, can be effectively reduced by early ambulation.


Fatal myocardial infarction in marathon racing. A 44-year-old trained marathon runner collapsed after completing 24 miles of the 1973 Boston Marathon. He was resuscitated from ventricular fibrillation. Death occurred after 50 days of coma. Extensive transmural anterior myocardial infarction was documented on electrocardiogram and proved at autopsy, yet the coronary arteries were free of significant atherosclerosis. We believe this report to be the first documentation of a myocardial infarction in a trained athlete while participating in a marathon. We emphasize that the relation between exertion and infarction is unknown. Advocates of long distance running for prevention of, or rehabilitation from, ischemic heart disease should be aware of this possible complication.


Rocky Mountain spotted fever: epidemiology of an increasing problem. Reported cases of Rocky Mountain spotted fever in the United States have been increasing since 1960 and reached an all-time high of 754 cases in 1974. Detailed clinical and epidemiologic information was obtained on 1522 (55%) of the 2757 cases reported in the 5-year period 1970 through 1974. Fifty-one percent of cases were confirmed by one or more laboratory test. The increase has occurred predominantly in the southeastern part of the United States. A comparison of laboratory-confirmed and unconfirmed cases suggests that a variety of febrile exanthems may be confused with Rocky Mountain spotted fever. Neither a history of tick bite nor rash was universally present, and both were significantly less frequent in fatal cases. The overall death-to-case ratio during this period was 6.8%. Death-to-case ratios were significantly higher for nonwhites (13.9) than whites (5.8), for male patients (8.2) than female patients (4.5), and for person older than 30 (13.9) than persons younger than 30 (5.4).


Treatment of recurrent symptomatic ventricular tachycardia. Eleven consecutive patients with recurrent ventricular arrhythmias were treated by an aggressive protocol and followed up prospectively. Arrhythmias, symptoms, and cardiac lesions were defined. Antiarrhythmic drugs were given on schedule, with blood levels determining dose; success or failure was defined by elimination or recurrence of symptomatic arrhythmias. When drug therapy failed, left ventricular aneurysmectomy was done when appropriate. Recurrent ventricular tachycardia was most frequently responsible for symptoms; coronary artery disease was the most frequent underlying disease. Symptomatic arrhythmias were eliminated in 8 of 11 patients (5 with drugs and 3 with aneurysmectomies), with a 16.5-month symptom-free average follow-up. An average of 2.9 therapeutic trials per patient was needed to control symptomatic arrhythmias. The average time from entry into the study until the start of ultimately effective therapy was 18 days. Therapy that eliminated symptoms did not eliminate all premature ventricular contractions, and occasionally even brief asymptomatic episodes of ventricular tachycardia persisted. Recurrent symptomatic ventricular arrhythmias can be controlled in many patients by rigorous application of current therapies.


Familial mitral valve prolapse and myotonic dystrophy. When a patient with mitral valve prolapse was found to have myotonic dystrophy, his family was studied to ascertain the occurrence of these abnormalities. Of 25 relatives screened, 8 had evidence of both myotonic dystrophy and mitral valve prolapse and 2 had evidence of myotonic dystrophy alone. Thirteen patients had evidence of neither condition and 1 had mitral valve prolapse alone. The association of these two conditions within a family has not previously been observed and valvular heart disease has not been recognized in myotonic dystrophy. This association should be looked for in other patients.


Acute renal failure due to nontraumatic rhabdomyolysis. Twenty-one patients developed acute renal failure in association with nontraumatic rhabdomyolysis and myoglobinuria. The illness followed an overdose of ethanol, heroin, or other depressant drug in 18 patients. Lethargy or coma was present in 17 patients and muscle swelling in 11. Evidence of rhabdomyolysis included markedly elevated creatine phosphokinase, myoglobinuria, and aldolase in blood. Initial biochemical findings were similar to those of acute renal failure due to other causes, but the abnormalities were exaggerated. There was a disproportionate rise in serum creatinine concentration in relation to serum urea nitrogen concentration. Profound hyperuricemia was present in most patients. Transient hypercalcemia developed during the diuretic phase in 5 patients. One patient died. We conclude that nontraumatic myoglobinuria with acute renal failure is not infrequent and may occur after an overdose of ethanol or heroin. The disease has good prognosis despite severe hypercatbolism and untreated profound hyperuricemia.


Defective triglyceride removal in lipemia associated with peritoneal dialysis and haemodialysis. Plasma lipids were measured in 78 uremic patients receiving either chronic peritoneal dialysis or haemodialysis. Type IV hyperlipemia was found in 60% of patients. The lipid level was not influenced by dietary habits or patient's age. Patients on chronic peritoneal dialysis had a significantly higher and more sustained hyperlipemia than the patients on haemodialysis. Triglyceride turnover studies showed that all patients, regardless of the type of dialysis or lipid level, had impaired triglyceride removal as the cause of this lipemia. This defect in triglyceride metabolism was only partially corrected by increasing the efficiency of the dialysis.


Coccidoidouria: clinical significance.

Coccidoidouria: clinical significance. Twelve patients had urine cultures positive for Coccidioides immitis. Ten patients showed the usual criteria for dissemination, but 2 were believed, before urine culture, to have only chronic pulmonary involvement. In 8 patients, there was impairment of host defense mechanisms due either to associated disease or immunosuppressive drug therapy. Only 2 of 11 patients tested reacted to coccidioidin skin-test antigen. Colony counts of C. immitis in the first voided morning urine spacimens ranged from 0.03/ml to 17/ml. With prostatic involvement, colony counts in the expressed secretions ranged from 15/ml to 120/ml. The site of urinary tract coccidioidomycosis, which could be adduced in 9 patients, was the upper tract in 1, lower tract in 6, and in both upper and lower tracts in 2. In patients with lower tract infection, the prostate was involved in 4 and the epididymis in 2.


Recurrent staphylococcal abscesses associated with defective neutrophil chemotaxis and allergic rhinitis. Four patients with recurrent staphylococcal furonculosis and deep abscess formation were evaluated to determine if a defect in the host defense mechanism could account for the unusual incidence of infection. Each also suffered repeated allergic rhinitis, often preceding the onset of infection. A marked defect in neutrophil granulocyte chemotaxis occurred when the patients were symptomatic with rhinitis and abscess formation. Their mean chemotactic index (+/- SD) was 16 +/- 6, while that of 25 control subjects was 70 +/- 11. Neutrophil random migration, phagocytosis, bactericidal activity, and lymphocyte T-cell populations were normal, as were serum concentrations of IgA, IgG, IgM, and IgE. Serial neutrophil function tests revealed normal chemotactic responsiveness when the patients were symptom-free of allergic rhinitis and no longer having abscesses. Abnormal function returned, however, when symptoms recurred. These studies suggest that defective neutrophil function associated with allergic phenomena need not be accompanied by hyperimmunoglobulinemia E. Such defects may be intermittent, appearing when allergic symptomatology and infections develop.


Transbronchial lung biopsy via the fiberoptic bronchoscope in sarcoidosis. In a prospective study at two medical centers, 42 consecutive patients with suspected sarcoidosis underwent transbronchial lung biopsy during fiberoptic bronchoscopy. Transbronchial biopsy revealed noncaseating granulomas in 24 of the 38 cases (63%) in which adequate tissue was obtained. Special stains and cultures for acid-fast bacilli and fungi were negative, and sarcoidosis was subsequently diagnosed in all 42 cases. Positive biopsies were obtained in 11 of 20 patients with radiographic stage I disease, in 11 of 15 with stage II disease, and in 2 of 3 with stage III disease. There was a higher probability of a positive biopsy in patients with high symptom scores for cough, wheezing, and dyspnea, and in those with a vital capacity of less than 80% of predicted. The only complication was one small pneumothorax, which spontaneously resolved. Transbronchial lung biopsy is an attractive initial procedure for obtaining histologic confirmation of sarcoidosis.


Avascular necrosis of the femoral head with combination therapy. Four patients with malignant lymphoma who were treated with multiple courses of combination chemotherapy, consisting of cyclophosphamide, Oncovin, procarbazine, and prednisone (COPP), developed avascular necrosis of the femoral head(s). Disorders usually associated with the development of avascular necrosis were absent. The total prednisone dose received by each patient was small. Avascular necrosis of the femoral head should be considered in the differential diagnosis of bone pain in patients receiving multiple courses of combination chemotherapy.


Rifampin.

Rifampin. In 1971, rifampin was approved for treatment of pulmonary tuberculosis and asymptomatic carriers of Neisseria meningitidis. At present, the approved indications remain the same. However, rifampin in conjunction with at least one other antituberculous drug may be of great value in therapy of extrapulmonary tuberculosis and infections due to other susceptible mycobacteria. In addition, results of clinical trials in leprosy have been highly encouraging. Rifampin appears to induce light chain proteinuria in a majority of patients and has been implicated in suppression of both humoral and cell-mediated immune responses. However, these effects appear to have been of little consequence to treated patients. A variety of possibly immunologically mediated reactions to rifampin has been closely associated with irregular administration of the drug. These reactions and hepatic toxcity may be preventable in many patients. Rifampin or one of its congeners, alone or in combination with other antibiotics, may prove useful in treatment of various infectious, and possibly malignant, diseases.


[Post emotional syndromes (author's transl)]. On the basis of ten clinical cases of post emotional shock, the following aspects are discussed: the causal emotion and its characteristics, its psychological repercussions and the mechanisms involvent, the clinical patterns observed, both somatic and psychic, and their interpretation. Attention is called to the consequences of such emotions from the forensic view-point and the need to ascertain and specify the nature and intensity of the emotional trauma and the actual state of anxiety. Emphasis is laid on the difficulty of making expert appraisals and fixing equitable compensations, as experts differ and their approaches to the problem and also because of the functional character of sequela and their varying degree of severity.


Adverse reaction to intravenous fluorescein: evidence for sex difference. Males react adversely more frequently than females to intravenous fluorescein angiography, as shown in a study of 547 patients. Approximately 10% of all cases reacted: 12.8% of the male patients and 7.3% of the female patients had adverse responses. Nausea was most common; vomiting was infrequent, and urticaria rare (1.1%). Ten males as opposed to one female reacted markedly. More serious reactions did not occur during the 7 year testing period. No apparent cause for the increased frequency in the male cases was found.


Localization of intraorbital foreign bodies. A study was performed utilizing 3 mock eyes of different sizes to determine the precision and accuracy of 3 radiographic methods of localization of intraorbital foreign bodies. The Comberg method was found to be the most precise and accurate, next, the Sweet method, and then the modified spectacle frame method. However, the modified spectacle frame field expedient method of localization yielded a surprisingly high degree of accuracy in 2 of the 3 planes of reference, that is, mediolaterally and superointeriorly. A more accurate field expedient type of device which will permit greater accuracy in localization of intraorbital foreign bodies in the anteroposterior axis is currently under development.


Bilateral oculodermal melanocytosis.

Bilateral oculodermal melanocytosis. A case of bilateral oculodermal melanocytosis is presented in a Negro man. It is suggested that the term "nervus of Ota" be superseded by the more accurate and descriptive terms of "dermal melanocytosis," "ocular melanocytosis," and "oculodermal melanocytosis."


Ara AMP- a highly soluble new antiviral drug. While vidarabine (Ara A) is in several ways superior to idoxuridine (IDU) it still has the disadvantages of rapid inactivation and poor solubility. The monophosphate ester or vidarabine, Ara AMP, however, is metabolized very slowly in humans and is extremely soluble with good tissue penetrance. The present study indicates that Ara AMP drops are equipotent or superior to vidarabine ointment in treatment of type 1 and type 2 herpes simplex keratitis. While iritis was significantly less in all treated groups, a suspicion of chemical side effect was raised but could not be proven in subsequent toxicity tests.


Reversible bilateral simultaneous papillitis with no light perception. This 14-year-old patient with bilateral simultaneous papillitis experienced no light perception in either eye for 24 hours and had a complete recovery of central and peripheral vision 3 weeks later. Fluorescein angiography confirmed the diagnosis. Although her hospital work-up was negative except for a mildly elevated CSF protein, it seems most likely that this was a postviral syndrome based on the bilaterality, rapid recovery of vision, and the age group.


Phacofragmentation and irrigation.

Phacofragmentation and irrigation. Phacofragmentation and irrigation is an excellent operation for easy extracapsular removal of cataracts through a small limbal incision for patients without significant nuclear sclerosis. Although the technique can be used in the senile age goup for special situations, it is not recommended as a substitute for the routine intracapsular operation for those patients with moderate to severe nuclear sclerosis. For good, consistent results, patient selection, animal practice, and familiarity with the operating microscope are important.


The relationship between hydrocortisone acetate distribution and efficacy in inflamed eyes: continuous vs intermittent delivery. Hydrocortisone acetate was administered to rabbit eyes intermittently in 250mug doses (given twice daily or once hourly) or continuously at 10mug/hr from an experimental ocular therapeutic system. Tissue drug distribution was measured over a 1 to 4 day period in experimental conjunctivitis. Anti-inflammatory efficacy was evaluated over a 4 day period in the same model. Statistically significant improvement in inflammation was observed 48 hours after initiation of continuous delivery treatment and after 4 days of the twice daily eyedrop regimen. Drug uptake by ocular tissues correlated with drug efficacy. Continuous delivery at 10mug/hr produced conjunctival steriod concentrations exceeding 1mug/g during 8 through 24 hours of treatment, and average levels of 1mug/g from days 2 through 4. Conjunctival steroid concentations generally did not exceed 1mug/g in eyedrop treated eyes until the fourth treatment day, when their clinical improvement matched that observed in the continuously treated eyes.


A stereological analysis of venous nicking observed at retinal arteriovenous crossings. The accepted hypotheses for the explanation of retinal venous nicking are critically reviewed and an alternative hypothesis based on a stereological analysis is presented. The ophthalmoscopic appearance of retinal venous nicking is best explained by partial collapse of the vein with the major axis of the venous cross section at right angles to the internal limiting a membrane of the venous blood flow nor of the likelihood of tributary vein occlusion. A partially collapsed vein may be very sensitive to small changes in intraocular pressure. Patients with impending tributary vein occlusion may benefit from reducing intraocular pressure.


Relative hypermetropia: a conception of Donders fallen into oblivion. Donders created 2 triads in connection with hypermetropia. The first is well known: Ht = Hm + H1. The second is a division into facultative, relative, and absolute hypermetropia. In present ophthalmic literature the second triad is confused with the first; the important member called relative hypermetropia is not even mentioned. I tried to find the cause of this misunderstanding. In my opinion the second triad--in the form Hess had given to it--should be placed among the basic informations of ophthalmology.


Tissue culture studies of contact lenses. Standard methylmethacrylate hard contact lenses and several available soft (HEMA) contact lenses were studied in tissue culture using secondary rabbit kidney cells. No toxic constituents were found but the cells were readily destroyed by a keratoprosthesis which was found to be toxic in culture. The tissue culture technique should assist in determining which plastics are most suitable for in vivo use and make conclusions concerning mechanical or metabolic effects of lenses more meaningful.


Postpartum uveitis.

Postpartum uveitis. A review of the literature supports the concept that serum levels of corticosteroids are elevated during pregnancy. Even a concurrent increase in cortisol-binding globulin (CBG) does not entirely neutralize the increased levels of cortisol. Thus, body tissues are exposed to more free cortisol than in the nonpregnant state. After delivery there is a rapid reduction of serum corticosteroids to the nonpregnant level. A granulomatous disease such as sarcoidosis may be suppressed by the high serum cortisol level. In the puerperium with a reduction of the serum cortisol, exacerbation of such a disease is likely. The case presented demonstrates this phenomenon.


The diagnosis and treatment of abduction deficiencies. Deficient abduction can be due to both innervational deficiencies and/or mechanical restrictions. Innervational deficiencies include lateral rectus weakness or paralysis, myasthenia gravis, progressive external ophthalmoplegia nd Duane's syndrome with aberrant innervation to the lateral rectus muscle. Mechanical causes include restrictions on the medial side of the globe (a tight medical rectus due to endocrine ophthalmopathy, a contractured medial rectus muscle as a result of a lateral rectus paralysis, excessive resection of the medial rectus muscle, scarring and hemorrhage due to multiple previous operations upon the medial rectus), as well as a posteriorly inserted lateral rectus. This latter condition may result from a traumatically disinserted lateral rectus muscle, an excessively recessed lateral rectus muscle or a lateral rectus that has slipped from its attachment following strabismus surgery. Insufficient force for full abduction is caused by posterior insertion of the lateral rectus. The diagnosis of these various conditions is considered with reference to the forced duction, force generation and saccadic velocity tests. The treatment of these different causes of abduction deficiency is discussed noting that the approach to treatment depends upon the etiology of the abduction deficiency.


Adverse systemic reactions of topical cyclopentolate hydrochloride. Systemic toxic effects of 2% cyclopentolate eye drops were studied in 66 adults. Out of these, 10 developed systemic toxic reactions. In 6 cases it was mild and in the remaining 4 cases the severity was moderate. Recovery was complete without any treatment. It is suggested that the use of 2% cyclopentolate drops should be restricted, and weaker concentrations applied with caution.


Examination of the ocular fundus with monochromatic light. Pure colored light in a narrow spectral band improves ophthalmoscopy and photography of the human ocular fundus. The contrast of fundus details is enhanced and the loss of quality of the image associated with chromatic aberrations is eliminated. The monochromatic technique also improves the localization of structures in the stratified layers of the fundus. Monochromatic photographs of a normal fundus and different pathologic cases are presented and discussed.


Fluorescein angiography in syphilitic retinal vasculitis. A case of ocular syphilis with severe ischemic retinopathy, rubeosis iridis and secondary glaucoma is described. Fluorescein angiography revealed a complete blockage of all the vessels around the macula, with dye leakage from numerous bifurcations of veins and an infiltrative mass in the macular area of both eyes. Combined treatment with steroids and penicillin brought no improvement in this condition of severe, ischemic ophthalmia.


Tendon-lengthening in squint surgery.

Tendon-lengthening in squint surgery. A procedure of tendon-lengthening to correct horizontal deviation of squinting eyes is repopularized. The principle is that the internus rectus muscle is exposed and divided into 3 portions which after suturing will form one elongated portion. Technique, dosage, suturing materials, instrumentation, disadvantages and advantages as well as postoperative care of this method are discussed.


Bulging iris-lens in cataract extraction. The basic cause of iris-lens diaphragm bulging during cataract extraction is thought to be increased choroidal venous congestive pressure. This is shown to be controlled by hyperventilation under general anesthesia.


Mastoid and middle ear cavity obliteration for control of otitis media. Total soft tissue obliteration of the mastoid-middle ear cavity and primary closure of the external auditory meatus were employed in six patients to control chronic suppurative otitis media. Previously, all these patients had unsuccessful surgery and all but one had profound loss of cochlear function. Thorough removal of cholesteatoma, granulation tissue, and ear canal skin is necessary before total obliteration can be performed safely. Wound healing was complete by one to two weeks postoperatively and all patients have been asymptomatic for two to seven years.


Observations on normal and degenerating human otoconia. Specimens of human otoconia obtained from autopsy material and representing various stages from fetal to advanced old age, were studied by microdissection, scanning electron microscopy, electron microprobe analysis, and x-ray powder diffraction. The typical adult otoconial configuration is a cylindrical, finely serrated body with pointed ends; crystallographically, it corresponds to a single crystal of calcite. Other, less numerous typed include jointed otoconia, pure rhombohedrons and multifaceted, presumably immature forms. Many otoconia achieve the adult configuration during fetal development. The multifaceted otoconia are most numerous, and the rhombohedrons proliferate, during childhon in the young adult, but saccular otoconia are the larger. In middle and advanced age the otoconia decrease in number, especially in the saccule. Saccular otoconia degenerate progressively in a posteroanterior direction across the macula; they assume a specific, fibours, hollowed-out appearance, which is not duplicated by either chemical etching or autolysis. Neogenesis and growth of otoconia appear to occur postnatally, with different characteristic growth potentials for those of the saccule and the utricle. Age-related saccular otoconial degeneration appears to involve the organic material, which disappears either before or simultaneously with the mineral substance.


Posterior cricoarytenoid as a speech muscle. It is well known that the posterior crioarytenoid muscle (PCA) is the only abductor of the vocal folds, but its role in speech has not fully been clarified. Our recent electromyographic (EMG) studies indicate active participation of PCA in the production of voiceless consonants and breathy phonation in different languages. In the experiments to be reported here, computer-averaged EMG data were obtained from PCA of native speakers of American English, Japanese, and Danish who uttered test words embedded in frame sentences. The results indicated that there was consistent increases in PCA activity for the voiceless portion of the test words. The EMG results were compared to the degree of glottal opening estimated by means of the fiberoptic technique. It was suggested that the degree and timing of PCA activity were directly responsible for determining the size and temporal course of the glottal opening for voiceless segments, although the suppression of the adductors might also have to be taken into consideration for a complete description of voiceless segment production.


Electrically evoked taste threshold.

Electrically evoked taste threshold. How accurately can the electrically evoked taste threshold be determined? Why have standards of normal values not yet been generally accepted? In order to answer these questions, 80 normal subjects were examined by means of the method of adjustment. The results showed a greater variability of threshold values and side differences than found by other authors. In explanation, it is suggested that the method of adjustment minimizes the biasing effect of the examiner, which normally leads to an underestimation of the threshold variability as well as of the side differences. The method of adjustment is therefore suitable for certain experimental purposes. For clinical use, a simple procedure like Krarups should be preferred. Due to its limited validity, however, only side differences of 100% or more should be considered pathological. A log-scale with rather large units (25% increment steps) is recommended.


Unilateral endolymphatic hydrops and associated abnormalities. A case of unilateral endolymphatic hydrops is presented in which several significant histopathological findings are observed in the affected inner ear and are absent in the opposite ear. Moderate endolymphatic hydrops is present in all cochlear turns on the involved side. Atrophic changes in the cochlear and vestibular end-organs, partial collapse and infolding of Reissner's and the saccular membranes, and collapse of the posterior canal membrane are also seen. There is also marked narrowing of the proximal rugose portion of the endolymphatic sac, associated with a flattened, epithelial lining, dense fibrotic connective tissue, brown pigment deposition, and poor vascularity in a relatively narrowed and straightened vestibular aqueduct. Fibrosis, loss of vascularity, and brown pigment deposition are also observed in the bony channels surrounding the vestibular aqueduct.


Vocal shimmer in sustained phonation of normal and pathologic voice. Vocal shimmer during sustained phonation was measured in normal subjects and patients with laryngeal polyps, using the mean amplitude difference between consecutive cycles expressed in dB. A small laboratory computer was then used for measuring each discrete amplitude and for data processing. The results showed some overlap between the values for two groups studied, but nevertheless it appears that the measured value may be a useful index in screening for laryngeal disorders and for definitive diagnosis of such disorders.


Tissue culture of human adult adenoids and of middle eear mucosa. The increased number of mucus producing cells as well as the presence of stratified squamous epithelium in pathological and experimental middle ear conditions, point towards the possibility of metaplastic changes of the middle ear mucosa, similar to the metaplastic capabilities of respiratory mucosae in general, as observed clinically or provoked experimentally. The purpose of this study was to develop a model of postembryonic human respiratory mucosae, in vitro, for the study of triggering or inducing factors involved in its normal and metaplastic differentiation. Explants from adenoids and middle ear mucosa were cultured, both as organ cultures and monolayers, for periods of up to two weeks, and their developmental characteristics were studied and described. Over 50% of the explants showed mitosis, epithelial and monolayer growth, ciliary activity and differentiation into ciliated and into mucus-producing cells. Adenoid explants were grown in air without and with added 5% CO2. Under the latter conditions, the proportion of explants and monolayers showing ciliary activity was 50% greater. It is concluded that this model might be suitable for further studies of the factors which control cyto-differentiation in mucociliary epithelia. Maintaining its growth for a longer period would, however, be desirable.


Pigmented lesion of the middle ear: report of a case. Melanotic lesions of the mucosal membranes of the head and neck have been reported infrequently. Malignant melanomas are reported with much more frequency than benign nevi in this region. The first reported case of a nevus of the middle ear mucosa is presented. The distinctions between this lesion, nevus of Ota, meningioma, Schwannoma, and hematoma are discussed. The malignant potential for this lesion is not known, but it appears low enough to obviate interval tympanotomy.


Rapid, atraumatic method for obtaining nasal mucus samples. Disposable cellulose acetate sponges, properly placed in the nose, provide a rapid method of stimulating the production of nasal mucus to be obtained for study. There is little trauma to the nasal mucosa, thus minimizing the risk of contamination of samples with serum or cells. The mucus is not diluted, and therefore, quantitative measurements of immunoglobulins and other substances can be made.


Leiomyosarcoma of the nasal cavity and paranasal sinuses. A case of leiomyosarcoma of the nasal cavity and paranasal sinuses is presented along with a review of the medical literature. The clinicopathological aspects of this tumor are discussed. The mode of treatment is complete surgical excision with close follow-up due to its high rate of local recurrence. The long-term survival with recurrent disease in this case is unusual.


Initiation of reflex glottic closure.

Initiation of reflex glottic closure. Review of the literature reveals scant information regarding the initiation of reflex glottic closure. Using the adult cat as our experimental model, we have attempted to analyze both the ipsilateral and crossed laryngeal adductor responses involved in reflex closure of the glottis. These ipsilateral and crossed reflexes are particularly well developed in the cat allowing their study with relative ease. From multifiber and single unit recurrent laryngeal nerve preparations, detailed descriptions of both peripheral and central neural organizations of these reflexes may be obtained. These data further elucidate the mechanism for initial incoordination of the glottic closure reflex, resulting from weak stimulus applied simultaneously to both superior laryngeal nerves, or from unilateral superior laryngeal denervation due to surgical trauma, metabolic neuropathy, or direct tumor involvement.


Ear-cough (Arnold's) reflex.

Ear-cough (Arnold's) reflex. A clinical survey of 688 patients revealed an incidence of Arnold's reflex in 1.74% of a general otolaryngology clinic population. There was no definite age, sex, or racial correlation found. The reflex was found unilaterally as well as bilaterally and in each canal quadrant, which is contrary to the previously described distribution of the nerve to the posterior and inferior parts of the canal. There was no predilection of a positive reflex with any particular ear disease.


Microbiology of the canine nasal cavities. The microbiota of both nasal cavities were investigated in 37 dogs by both aerobic and anaerobic techniques. The predominant microorganisms were composed of enterococci and staphylococci. A surprisingly high incidence (46%) of Gram-negative rods was noted from the inferior portion of the nose. Microorganisms from the superior region of the nose, as obtained with a surgical approach, differed both qualitatively and quantitatively from the respective transnasal cultures. Thus, it appears that different bacterial populations are present within various anatomic regions of the nose and a routine transnasal culture cannot accurately reflect the microbiology of the entire nasal cavity.


Mega-antrum.

Mega-antrum. Mega-antra may masquerade as destructive lesions of the antral portion of the temporal bone. Awareness of this entity and correlation with the physical and roentgenological examination could prevent surgical exploration of the temporal bone. New upper range size limits can be expected as mega-antra become more commonly identified.


Unusual presentation of a large leiomyoma of the esophagus. A case is presented with a giant pedunculated leiomyoma of the esophagus. The difficulties of diagnosis are presented along with a review of the literature. Surgical removal is safe and curative.


Epidermoid carcinoma arising from within an epidermoid inclusion cyst. The unusual occurrence of epidermoid carcinoma within an inclusion cyst arising on the forehead of a patient is documented. The importance of any irregular change or clinically abnormal behavior in such a lesion is underscored and the necessity for routine histological examination of all tissue excised is reaffirmed.


[The tegument of Euzetrema knoepffleri, endoparasitic Monogenean of an amphibian: ultrastructure and evolution during the life cycle (author's transl)]. Euzetrema knoepffleri is an endoparasitic monogenean from the bladder of an Amphibian. Ultrastructural studies of the integument are made during the three stages of the life cycle: oncomiracidium, renal post-larva and adult. The meaning of the structures is discussed during the larval evolution to the adult and is compared with that of other monogeneans. The transition from fresh water to an urinary environment is in relation with the folding of the internal cytoplasmic membrane. This adaptation is specialized in water and ion transport through the integument, necessary for for the osmotic readjustment of the parasite:  It has been noted that the tegument integrates ultrastructural adaptations to the biotope, independent of the phylogeny.


Intermittent chemotherapy of pulmonary tuberculosis using rifampicin and isoniazed for primary treatment: the influence of various factors on the frequency off side-effects. After studying more than 1,000 siphonaptera  tera collected from about 300 wild carnivora (with a majority of foxes, Vulpes vulpes), in the North-east of France, the authors state more precisely the biology and chorology of the main fleas collected: Pulex irritans, Ctenocephalides felis felis, C, canis, Chaetopsylla globiceps, Ch. rothschildi, Ch. trichosa, Paraceras melis melis. 9 other species are also noted.


[Attempt to determine by chaetotaxy the genus of a microphallid cercaria parasiting Cerithium meditteraneum Deshayes (author's transl)]. Chetotaxy of a cercaria parasite of Cerithium meditteraneum is studied. Sensory receptors C III, St V, St DL, AID, PI and U, are similar to those of Maritrema linguilla and Maritrema subdolum. However in the three cercariae, the ventral, dorsal and lateral papillae, except AID and PI (V, L, D) are different. The chetotaxy of this cercariae shows that they belong to the genus Maritrema. Investigations of the biological cycle are under way to verifie this hypothesis.


[The advantage of an association of Zonitidea snails in biological control of Lymnaea (Galba) truncatula on siliceous and calcareous field (authors transl)]. The predation rate of L. truncatula is increased by this association when habitats drying. The results are negative in swampy meadow -- habitats on siliceous soils.


[A study of parasitic trematodes of Littorina saxatilis and their impact on this mollusc (author's transl)]. A monthly study of populations of Littorina saxatilis (mollusc, gasteropod) very strongly parasited has allowed to establish relations between the said mollusc and some parasite trematodes which live in it. A selection of animals was done in two stations of the Roscoff region (Finistere). A total of more than 1.000 individuals have been examined in each station. Eleven species of cercairs have been spotted. It has appeared that the Microphallus similis was the most represented: 79,86% of the total. This rate of parasitism does not change much throughout the year. The populations of molluscs strongly parasited by Microphallus similis show an important castration. A double association of cercairs remains rare but is yet possible. It appears that aged individuals are the most parasited. It seems that there would be a growth of parasites more important in females than in males.


[Biological cycle of the nematode Rictulariidae: Pterygodermatites (Multipectines) affinis (Jägerskiold, 1904) (author's transl)]. Infestant larva of the Nematode Rictulariidae: Pterygodermatities affinis (Jägerskiold, 1904) are localized in Pimelia: Tachyderma hispida Forskael of Algeria. Through the infestation of a young cat, embryonated eggs are collected after 38 days of development altogether with a female parasite. The experimental cycle of this rictulariid nematode in Locusta migratoria is characterized by the shortness of its development and the similarity in growth during the first and second larval stages. The cellular reaction of the Insect to the larva P. affinis is weaker in the Pimelia than in the Grasshopper, used as experimental host.


[Description and life history of Tetrameres (Tetrameres) cardinalis sp. n (author's transl)]. A new species of Spirurid Nematode Tetrameres (Tetrameres) cardinalis n. sp. parasite of a Cardinal: Richmondia cardinalis is described. This Tetrameres shows primitive cephalic structures, 33 to 43 pairs of somatic spines in male, spicules of unequal length: left 365-440, right 65-350 mu, mature eggs with tufts of polar filaments. The life-cycle of this Spirurid has been obtained experimentally with the grass-hopper Locusta migratoria as an intermediate host. Its larval development is characterized by the quickness of organogenesis, the stability of cephalic structures from third stage to adult stage, the small size (800 mu) of infective larva, the localization of larva in the insect fat tissue.


[Aprocta cylindrica Linstow, 1883, an oviparous filaria parasite of ploceid birds from Tchad. Larval morphogenesis (author's transl)]. Aprocta cylindrica Linstow, 1883, was identified in Africa (Tchad) from Passeriform birds Ploceidae belonging to the species Quelea quelea quelea (L), Ploceus capitalis (Latham), P. cucullatus (Müller) and Euplectes orix (Insert). Its experimental life cycle achieved in Orthoptera Locusta migratoria allows the study of the three first larval stages.