Howell-Jolly bodies. A clue to splenic infarction. A 74-year-old woman with secondary erythrocytosis was found to have Howell-Jolly bodies in peripheral blood erythrocytes following acute splenic infarction. The Howell-Jolly bodies were a transitory finding and disappeared six days after the infarction, although the spleen remained abnormal by isotope scanning for several weeks. Careful inspection of the peripheral blood film may be an aid in the diagnosis of acute splenic infarction.


Renin-secreting clear cell carcinoma of the kidney. A young woman with mild to moderate hypertension and normal PRA, serum potassium levels, and urinary aldosterone excretion rate was found to have a renal tumor by selective renal arteriogram. Renal vein renin activity indicated an increased production of renin from the kidney containing the tumor. At surgery, a clear cell carcinoma of the kidney was found that contained renin activity in excess of the surrounding kidney tissue. The renin activity appeared identical to human kidney renin. Previous renin-producing tumors have been associated with severe hypertension, elevated plasma renin activity, hypokalemia, and elevated urinary aldosterone excretion. This case should call attention to the renin-secreting tumor as a cause of even mild hypertension.


Hyperinsulinemic hypoglycemia associated with a neurofibrosarcoma. A patient with a posterior mediastinal malignant neurofibrosarcoma and recurrent episodes of severe hypoglycemia was demonstrated to have basal hyperinsulinemia on repeated study. Despite hypoglycemia, there was no glucagon response to aminogenic stimulation. No immunoreactive insulin was detected on extraction of the tumor and no secretory granules of beta type were seen on electron microscopic examination of tumor tissue. Following tumor removal, plasma glucose and insulin levels returned to normal. Alpha cell function improved. These findings suggest stimulation of pancreatic beta cell secretion and possible inhibition of alpha cell response by an extrapancreatic tumor.


Narcissism and the readiness for psychotherapy termination. The readiness for termination of psychotherapy is considered from the perspective of the importance of the narcissistic features. After a guiding theoretical orientation, several case vignettes are presented that illustrate outstanding changes in the patient's self seen during the terminal phase of psychotherapy. These include the re-experiencing of narcissistic injury, a differert response to interpretation, and a substantial alteration in the reaction to disappointment.


Differentiating criteria for acute-chronic distinction in schizophrenia. Type of onset, presence of precipitating events, mental status, and premorbid instrumental functioning, commonly associated with prognosis in schizophrenia, were studied in relation to the acute-chronic distinction and short-term outcome in 641 schizophrenic patients. Contrary to the general position held by some researchers, none of the clinical predictors (type of onset, precipitating crises, and mental status) appeared to distinguish the two types of schizophrenics, or to contribute substantially to the prediction of readmission. Preadmission social functioning of the two patient groups was more similar than generally indicated by previous reserach. As regards prediction of short-term rehospitalization, the study identified poor relationships with parents, friends, and opposite-sexed peers as important factors for acute patients and antisocial behavior and inability to relate to the opposite sex and others in the community as important variables for chronic patients.


Amphetamine-induced dopaminergic hypersensitivity in guinea pigs. Implications in psychosis and human movement disorders. Following chronic amphetamine pretreatment, guinea pigs demonstrate an increased sensitivity to both d-amphetamine sulfate- and apomorphine hydrochloride-induced stereotyped behavior. This observation suggests that chronic exposure to high doses of a dopamine agonist (d-amphetamine) alters the response of the brain to the subsequent administration of both indirect (d-amphetamine) and direct (apomorphine) dopamine agonists. This altered response may be due to the development of dopamine receptor site hypersensitivity. Clinical evidence suggests that a similar agonist-induced hypersensitivity may play a role in the development of dyskinetic movement disorders and psychoses in humans following the chronic use of such dopamine agonists as amphetamine and levodopa.


Hypothalamic-pituitary function in anorexia nervosa. We studied nine patients with anorexia nervosa: five were "undernourished" and four were "well-nourished". The undernourished patients had significantly higher plasma growth hormone (GH) levels in a fasting state and higher GH rebounds following glucose administration. In four of these patients, GH levels decreased to normal after weight restoration. Decreased urinary follicle stimulating hormone (FSH) in three and plasma luteinizing hormone in six patients were not related to nutritional status; however, positive correlation was found between duration of illness and urinary FSH. Other results included decreased plasma testosterone in the one male, elevated plasma cortisol in five, and decreased 17-ketosteroid excretion in five patients. The results support elevated GH as secondary to starvation of anorexia nervosa and not an independent hypothalamic-pituitary disturbance. Other endocrine findings indicate hypothalamic-pituitary malfunction is not confined to GH.


The impact of mass transfer on patient release. In 1971, budget restrictions in New York State provided the impetus for the transfer of 2,174 patients among state hospitals in the mental hygiene system. The discharge rate was greatly increased over what would have been expected, but varied greatly among the receiving hospitals. The major factor relating to this difference appears to be the values and beliefs of the receiving hospitals as to the proper placement of patients. The patient's return to the hospital after discharge did not relate to a liberal discharge policy, but seemed to depend on whether or not the patient was physically healthy and could meet minimal social role expectations. Factor usually associated with probability of discharge are analyzed, but while some, such as age, affect chances of discharge, none are as potent predictors as the type of hospital.


Effeminacy. I. A quantitative rating scale. Although effeminacy is recognized to be a complex and important phenomenon, until now it has been only scantily studied, and has not been clearly defined or measured. In this paper, we review the literature and present an Effeminacy Rating Scale that quantifies the behavioral fragments comprising the overall clinical picture of effeminacy. We also present data obtained in a trial of the scale on a sample of 16 homosexual and 16 heterosexual males. The scale was found to have a high interrater reliability (0.93) and can therefore be used to study effeminacy quantitatively.


Effeminacy. II. Variation with social context. In Part II, effeminacy in an in vivo social situation was studied and the Effeminacy Scale described in Part I was tested. Nineteen subjects were studied and videotaped while participating in four encounter groups, of which two were homosexual and two heterosexual. There were large situational variations in expressivity of effeminacy during group meetings. High-frequency levels of effeminate responses were observed to parallel high levels of anxiety or anger. At other times, effeminate responses were observed which seemed to subserve sexual signaling functions or which seemed related to narcissistic retreat (self-cuddling) or castration anxiety (e.g., cupping the genitals). Interrater reliability with the Effeminacy Scale for two nonprofessional raters viewing the same videotaped material from the group was 0.93 (Pearson r).


Traumatic phallic amputation during infancy. An unusual case of phallic amputation is reported because it highlights the complex issues involved in considering transsexual surgery during early life. The lack of ambiguity regarding this patient's physiological gender at the age of 15 months permitted his management to rest solely on the long-range social and developmental implications of his phallic defect. The impact of this event on the child's family, on the community, and on professional workers was profound, leading to a series of circumstances that affected objectivity and the decision-making process. The decision to retain the male gender was based on the uncertain long-range effects of the loss of capacity for procreation and the surgical procedures and hormone therapy necessitated by gender change.


Ablatio penis: normal male infant sex-reassigned as a girl. Forty-five cases of genetic males were assigned and habilitated as females, 43 because of a congenitally defective penis (micropenis with or without hypospadias), and two because of infantile ablatio penis. One of the latter has an identical twin brother as a control. Now 9 years old, she has differentiated a female gender identity in marked contrast to the male gender identity of her brother. Some of the other patients are now adolescent or adult in age. They demonstrate that the twin can expect to be feminine in erotic expression and sexual life. Maintained on estrogen therapy, she will have normal feminine physique and a sexually attractive appearance. She will be able to establish motherhood by adoption.


Premarital coitus and commitment among college students. In contrast to some popular speculations about a massive increase in sexual behavior labeled "permissiveness without commitment," this survey of 2453 undergraduate students from four geographical areas in the United States provides data which suggest a behavioral pattern of "permissiveness with commitment." This pattern of "coitus with commitment" was evident not only for females, but for males as well. With minor exceptions, the pattern was detected for both sexes in all four geographical regions. Speculation is made about ways in which this pattern may be one outcome of the alleged intersex convergence in sexual attitudes and behavior among American college youth. Implications are drawn for the increment of theory.


Transsexualism in Vietnam.

Transsexualism in Vietnam. The case described is that of a man raised in the Vietnamese peasant countryside who clearly fits the transsexual syndrome. On physical examination he appears to be a normal male, yet he insists that he is a female. He dresses as a woman and is able to successfully "pass" in society. He relates that he felt he was a female from earliest childhood. He prefers nonhomosexual men, denies any heterosexual experience, and has an all-consuming desire for the sexual transformation operation. This paper focuses on the social aspect of transsexualism and the manner a society, particularly the Vietnamese, may handle transsexual behavior. These ways can be seen to fall into a continuum. On one end, sexual role reversal is institutionalized and transsexual-like behavior is carried on according to a prescribed cultural pattern. The Vietnamese "hermaphroditic witch" could be included in this category. In the middle of the continuum, the idiosyncratic transsexual is provided an acceptable cultural role, and he therefore should be visible when he occurs. The Vietnamese young person who cross-dresses could perhaps be in this category. On the other extreme, the transsexual role is not conceivable or, at best, is very marginal. Here, the transsexual remains hidden in the general culture and can only be detected, as the person described in this paper, by accident.


Sexuality in Samoan art forms.

Sexuality in Samoan art forms. This article explores the manifestations of sexuality in Samona as they are revealed through songs, poetry, dance, gestures, verbal expressions, stories, and games. For each of these art forms, texts, and translations of original material are presented, as an aid to discerning the uses and functions of sexuality as they are applied by Samoans for Samoans; to this end, formulalized joking of various types is seen as the medium through which the humorous element of sexuality is expressed. Elsewhere, sexuality functions to achieve and sustain individual attention. The explicitly sexuality functions to achieve and sustain individual attention. The explicitly sexual references in duneral and marriage songs, on the other hand, constitute affirmations of social values, incorporated in long-established rites. In what is tantamount to artistic license, performance of song, poetry, and dance containing sexual elements or references that would be prohibited in other contexts is constituted as acceptable behavior. In marked contrast to nineteenth-century writings, and the opinions of the popular press, sexuality in Samoa is far from free in its modes of expression, but rather adheres to traditional formalized patterns which determine its occasions, participants, and verbal and kinetic limits. Although not indispensable as a means of personal expression, it generally provides additional opportunities for the creative and aggressive individual to demonstarate his artistic talents and therby contribute to his own social elevation. As an element of verbalized group sentiment, it is a positive assertion of Samoan values, astatement of social solidarity.


Cognitive and hormonal factors accecting coital frequency. Sexual behavior of female undergraduates was assessed by daily questionnaries. Of the 24 subjects, 13 were taking oral contraceptives ("pill" subjects) and 11 were using other methods of birth control ("nonpill" subjects), primarily diaphragm or male prophylactic methods. Three main results were obtained: (1) Intercourse rates were lowest during menstruation and highest immediately following menstruation. (2) Self-rated sexual arousal on a given day correlated with the type of heterosexual encouters on that day rather than with period of the menstrual cycle. (3) Pill subjects reported intercourse on more days than nonpill subjects but reported a lower number of intercourse sessions on day with intercourse than nonpill subjects. These results are interpreted within a general framework of sexual behavior which recognizes the sexual behavior of humans as primarily influenced by cultural and cognitive factors. The possibility is discussed that female sexual behavior might also be found to be affected by hormones if more sensitive measures were used.


Secondary orgasmic dysfunction. I. Analysis and strategies for treatment. Following treatment of six cases of primary orgasmic dysfunction and six cases of secondary orgasmic dysfunction, an analysis of assessment and outcome data indicated that (1)clients with secondary orgasmic dysfunction and those with primary orgasmic dysfunction did not differ significantly in most aspects of sexual behavior before treatment; (2) before treatment, secondary orgasmic dysfunction tended to be associated with a disturbed marital relationship, while primary orgasmic dysfunction did not; (3) following a behavioral treatment program focused on anxiety reduction and sexual skill training, organism in coitus was attained by clients with primary orgasmic dysfunction but not by clients with secondary orgasmic dysfunction. Based on these findings, suggestions for effective treatment of secondary orgasmic dysfunction are made.


Secondary orgasmic dysfunction. II. Case study. The treatment of a case of secondary orgasmic dysfunction is described. In this case, a direct behavioral retraining program was employed to increase the couple's repertoire of effective sexual behaviors. An extinction and successive approximation procedure was used to transfer ortasmic responsiveness from solitary masturbation to heterosexual coitus. Since other data have indicated that nonsexual marriage problems contribute to the maintenance of secondary orgasmic dysfunction, a direct, confrontive intervention into the marital relationship was made concurrent with the sexual retraining program. Outcome data are presented to illustrate the effectiveness of the reatment procedures.


The sex offenses of blacks and whites.

The sex offenses of blacks and whites. Little is currently known about differences in the sex offenses of blacks and whites ii the 1nited states. Many major studies of sexual behavior and of sex offenders have purposely excluded data on blacks. This paper presents comparative data on 47 black and 47 white sex offenders in terms of the nature of the offense and victim characteristics. It was found that black offenders weremore likely than white offenders to engage invaginal intercourse with their victims, showed a trend to use force in their offenses, and were more likely to select adult female victims. These differences, however, appear to be due primarily to class rather than racial differences. Limitations of these dataare discussed.


The fetish object:  phylogenetic considerations. Direct observations of behavior evoked by a fetish object (wet shoe) in one patient are reported. The intrinsic qualities of an object endowing it with fetish power are reported. The intrinsic qualities of an object endowing it with fetish power are examined. Such qualities may be related to human perceptual preferences, a product of phylogeny, stemming from such factors as the primate interest in body parts and extracorporeal objects. The capicity to relate to an inanimate object including the assimilation of the object by variedmotor acts reflects the crucial role of objects (tools) in hominid evolution. Also phylogenetically based is the human capacity to assign mutiple meanings to an object.


Drug-induced colitis mimicking an acute surgical condition of the abdomen. Pseudomembranous colitis secondary to antibiotic therapy has received increasing recognition. During a one-year period, eight of 42 patients with this entity had findings closely resembling an acute surgical condition of the abdomen manifested by fever, leukocytosis, and severe abdominal pain and tenderness. All eight patients received clindamycin and two were also given lincomycin hydrochloride monohydrate. Differentiation from an acute surgical condition of the abdomen was difficult until the characteristic findings of pseudomembranous colitis were noted on proctoscopic examination. Unnecessary celiotomy was averted in all patients. Seven of eight patients responded to discontinuation of the antibiotic and supportive measures; one required a diverting ileostomy. Drug-induced colitis must be an important consideration in any patient recently receiving antibiotics who develops fever, abdominal pain, and diarrhea.


Secondary arterial repair. The management of late failures in reconstructive arterial surgery. The incidence and success of secondary operations after reconstructive arterial surgery were studied in a series of 4,247 cases of aneurysmal and occlusive arterial disease. Postoperative complications requiring secondary operations occurred, in order of frequency, as the result of defective healing (including infection), deterioration of the arterial implant, and degenerative arterial changes in the site of surgical intervention. A large variety of surgical techniques were used for correction, such as total replacement, segmental resection and replacement, remote bypass, thrombectomy, and partial excision and reanastomosis. Wth the exception of complications due to infection, the results of repair were good in 60% to 90% of the various categories; only 40% of the infected grafts could be managed without the loss of life or limb. The results appear to justify the trend noted in recent years to a more aggressive use of secondary, salvage operations.


Vascular injuries associated with fractures of the femur. Over a five-year period, 21 patients were seen with vascular injuries associated with fractures of the femur. In 19, vascular repair was performed at the time of the acute injury. The average interval from injury to repair was 15 hours. Arterial injuries included transection, intimal flap, laceration, avulsion, and false aneurysm. End-to-end repair was done in 11 cases, and autogenous vein grafting in nine. One artery was ligated for false aneurysm. In the 19 acute cases, internal fixation was used in eight; this method of immobilization resulted in two major amputations and three cases of anterior tibial compartment necrosis. Of 11 patients who had external immobilization, two eventually required amputation because of massive soft tissue injury. Internal bone fixation is not necessary for successful vascular repair and seemed to cause greater limb and tissue loss, probably due to prolonged ischemia time. If internal bone fixation is used, the artery should be repaired before the bone.


Pseudocysts of the pancreas. Review of 71 cases. During the period of 1962 to 1972, 71 patients underwent surgical treatment of pancreatic pseudocysts. Internal drainage was performed in 73% of these patients in comparison to only 20% in a series during the previous decade. From an analysis of results, it would appear that the treatment of choice is internal drainage via either cystogastrostomy or cystojejunostomy. Postoperative bleeding and sepsis were of negligible consequence. An unexpected finding was that the long-term results of these patients seemed to be better than those of patients with pancreatitis in whom pseudocysts did not develop.


Acute renal failure complicating ruptured abdominal aortic aneurysm. Ruptured abdominal aortic aneurysm complicated by renal failure is associated with a mortality greater than 90%. Aggressive management, which included the early use of hemodialysis, was employed. Between 1970 and 1973, a total of 43 patients had surgery for proved ruptured abdominal aortic aneurysm. Fourteen patients developed acute and fixed renal failure. Nine of these 14 patients had undergone hemodialysis with treatments beginning as early as the second postoperative day and lasting as long as ten weeks. There were six survivors, with a hospital mortality of 33%. This represents an improvement in survival compared with our earlier experience where the mortality in this type of patient was 93%. Early use of hemodialysis in the postoperative management of patients with acute renal failure complicating ruptured abdominal aortic aneurysm is recommended.


Acute perforated duodenal ulcer. An evaluation of surgical management. The surgical management of acute perforated duodenal ulcer has been evaluated in 360 patients. Simple closure was done in 254 patients, with a mortality of 6.7%, a morbidity of 21%, and an average hospital stay of 11.9 days. In 106 patients (29%) who underwent definitive operation for treatment of duodenal ulcer disease at time of perforation, the mortality was 2.8%, the morbidity was 15%, and the average hospital stay was nine days. Follow-up studies of simple closure in patients with no previous ulcer symptoms showed that 72% of the patients remained asymptomatic; in patients with previous ulcer symptoms, only 23% were asymptomatic. Definitive operation for acute perforation is indicated in good-risk patients who have a history of ulcers. Parietal cell vagotomy and simple closure was used in four patients with excellent early results.


Management of the recurrent ulcer.

Management of the recurrent ulcer. One hundred seventeen patients with recurrent ulcer were treated at the University of Michigan Medical Center. The most satisfactory results were obtained when vagotomy was employed in the surgical therapy. Seventy-one of 91 patients treated by operation had a satisfactory result. In nine patients a second operation was required, and three patients underwent a third operative procedure. Twenty-one additional patients were satisfactorily treated medically so that, overall, 92 of 117 patients (79%) had a good result. Twelve patients had residual symptoms and 13 were lost to follow-up. There were no deaths attributable to recurrent ulcer in the entire series.


Lobular carcinoma of the breast in situ. Are we too radical in its treatment? Twenty-four patients (average age, 46 years) with 29 instances of lobular carcinoma in situ of the breast have been treated from 1952 to 1971 at the Henry Ford Hospital (incidence, 1%). Six patients had bilateral lesions, one synchronous and 5 metachronous. The initial complaint in 23 of 24 patients was a mass in the breast. Diagnosis was based on permanent histologic section as mammorgraphy and frozen section analysis were inconclusive. Treatment consisted of radical mastectomy in six, modified radical mastectomy in five, and simple mastectomy in 20. All lymph nodes recovered showed no metastatic disease. All patients are alive and well with no evidence of disease. Based on our experience, we recommend a simple mastectomy for treatment of lobular carcinoma in situ with contraleteral bipsy examination in those instances when clinical or roentgenographic evidence suggests a pathologic process.


Acute acalculous cholecystitis. Complication of other illnesses in childhood. Seventy-four cases of acalculous cholecystitis in infants and children (seven personal cases and 67 from the literature) were analyzed. In 45 cases the cholecystitis appeared as a complication of another illness. The primary illnesses in our patients were leptospirosis (four cases), diarrhea (two cases), and third-degree burns (one case). All seven children were critically ill. Abdominal pain and an abdominal mass were present in all. Fever was present in six of the seven patients, jaundice in four. Tube cholecystostomies were done in all cases. After recovery from their illness, the five surviving patients had normal bilary tracts when studied by cholangiography via the tube. Acute acalculous cholecystitis in infancey and childhood as a complication of injury or illness should be treated as an undrained abcess.


Hepatic cell adenomas, spontaneous liver rupture, and oral contraceptives. During the past decade, an increasing number of hepatic cell adenomas have been reported. Sppntaneous rupture, a life-threatening complication of this rare tumor, has been noted more frequently. Eight patients with hepatic cell adenomas have been treated at our center. Three patients first developed symptoms from hemoperitoneum. Palpable tumors were discovered in three asymptomatic patients during routine examinations. Two patients had upper abdominal pain from intrahepatic hemorrhage. All patients were young women using oral contraceptive agents. Emergent hepatic lobectomy was performed in the three patients with rupture. The other five patients underwent selective angiographic studies, prior to elective liver resections. All survived operation and have done well since. The increased incidence of hepatic cell adenomas may be related to the use of oral contraceptive agents.


Arterial fibrodysplasia. Histopathologic character and current etiologic concepts. Arterial fibrodysplasia affected 196 patients (172 females, 24 males) harboring a total of 316 diseased vessels. Renal artery lesions were documented in 152 adult and 25 pediatric patients. Superior mesenteric, celiac, common hepatic, and external iliac arteries were occasionally involved. Intimal fibroplasia and medial hyperplasia are uncommon types of arterial dysplasia. Medical fibroplasia represents a continum of disease, including pathologic processes heretofore categorized as subadventital or perimedial fibroplasia. A previously unrecognized form of perimedial dysplasia, characterized by dense accumulations of elastic tissue about the periphery of the media, is reported as a distinct pathologic entity. Hormonal influences, traction-stretch stresses, and peculiarities in distribution of vasa vasorum in vessels affected by dysplastic processes may be prerequisite to the evolution of arterial fibrodysplasia.


A series of 20 successful Warren shunts. Recent reports suggest that the distal splenorenal shunt does fulfill its physiological promises. The portal and the gastroesophagealsplenic areas are divided into separate "venous watersheds." As a result, varices are decompressed but portal hypertension is preserved. It should, therefore, have its greatest advantage for patients with the most severe impairment of hepatic reserve. In this evaluation, the procedure was considered the operation of choice for all shunt candidates who had a patent splenic vein. A series of 20 patients, 12 with Laënnec cirrhosis, seven with postnecrotic cirrhosis, and one with Wilson disease, survived shunting and were discharged from the hospital. One patient died of hepatic coma eight weeks after operation. If lengthy follow-up studies confirm its capacity to prevent hemorrhage, the distal splenorenal shunt may be the safest elective shunt operation for patients with cirrhosis.


Acute gastric disease after cutaneous thermal injury. Diffuse erosive "gastritis" was discovered as early as five hours postinjury in 45 of 54 burn patients (83.5%) evaluated by gastroduodenoscopy. Acute ulcers were identified in 14 patients (26%); concomitant duodenal disease was present in 34 patients (76%). Microvascular fibrin thrombi were not demonstrated even though five patients had disseminated intravascular coagulation. Seven patients were examined before nasogastric intubation; four, with a mean burn size of 59.6% total body surface, had diffuse "gastritis." Low total serum protein levels were measured in 81% of tested patients, but were not predictive of mucosal disease. Hemorrhage followed the clinical deterioration of six patients (11.1%); one ulcer perforated. Whereas coagulation abnormalities, nasogastric intubation, and hypoproteinemia may augment mucosal injury, the morphologic and histologic examinations of the lesions suggested a primary ischemic cause resulting from the opening of submucosal shunts or local vasoconstriction.


Radioisotope detection of venous thrombosis. Venous scan vs fibrinogen uptake test. Experience with the fibrinogen uptake test and the technetium Tc 99m albumin aggregated venous scan in 89 patients showed the latter to be adequate for simultaneous screening for plumonary embolism and venous thrombosis of the lower extremities and pelvis. Because the fibrinogen uptake test differentiated active from inactive venous thrombosis, it is indicated when anticoagulation is considered for patients with a history of thrombophlebitis and equivocal clinical findings of acute activity. It can also be used to monitor high-risk patients and to detect proximal propagation of thrombi. The results of the technetium venous scan were abnormal in 97% of patients with venous thrombosis and the fibrinogen uptake test detected 100% of patients with acute activity. Both tests react to different aspects of the thrombotic disease, thus complementing each other. Because of their reliability, indications for phlebography are now less frequent.


Management of parathyroid glands in surgery for medullary thyroid carcinoma. Of  13 patients treated surgically for familial medullary thyroid carcinoma in whom parathyroid tissue was availabe, the majority showed parathyroid abnormalities (hyperplasia in sis, tumors in five). Two patients had had renal calculi. No correlation was evident between the presence of the parathyroid tumors and peripheral blood levels of parathyroid hormone. Hyperparathyroidism is usually mild, but occasionally it results in complications of hypercalcemia. Hyperparathyroidism has not appeared to date following removal of medullary thyroid carcinoma associated with normal-sized but microscopically hyperplastic parathyroids. Evidence of parathyroid abnormalities has not been recognized in eight patients with sporadic medullary carcinoma, making genetic factors dominant in explaining the association of parathyroid hyperplasia and this carcinoma. At operation, parathyroid glands should be evaluated and those that are grossly enlarged removed while preserving parathyroid function.


Success rate of cervical exploration for hyperparathyroidism. In a three-year experience with 361 patients who underwent exploratory surgery for hyperparathyroidism, the success rate for primary cervical operations was 95% and that for secondary operations (cervical and mediastinal) was 62%; for all operations, it was 94%. The three most important factors in determining successful cervical exploration of the parathyroid glands are correct preoperative diagnosis, meticulous surgical technique, and accurate determination of abnormal locations of pathologic conditions. Ancillary studies or techniques for preoperative localization of parathyroid tissue were utilized in only a few patients who had unusually complicated problems. The results of this study suggest that, because of cost, time involvement, and potential risk, selective venous sampling with radioimmunoassay of parathyroid hormone or arteriography or both should be reserved for complicated problems and for patients being considered for a second or third exploratory operation.


Esophageal stricture secondary to reflux esophagitis. Since 1966 we have used esophageal dilation plus Nissen fundoplication as our sole method of treating esophageal strictures caused by reflux esophagitis. Twenty-six patients were treated for esophageal strictures. Dysphagia, vomiting, and weight loss were the main complaints. All had roentgenographic evidence of esophageal stricture confirmed by endoscopy. All patients had preoperative or intraoperative dilation of the stenotic segment with a Hurst dilator, followed by Nissen fundoplication as the antireflux operation of choice. This more conservative approach, which corrects both the reflux and stricture problem, has not been associated with mortality nor has there been any morbidity associated with the dilation procedure. All patients thus treated have remained asymptomatic on normal alimentation for the follow-up period, which ranges from six months to seven years.


Posterior resection of selected rectal tumors. Villous adenoma is an unusual tumor  of the colon, occuring largely in the rectum, that can usually be cured by adequate local excision. Over a five-year period, seven patients with villous adenoma of the retroperitoneal rectum and one poor-risk patient with adenocarcinoma were treated by posterior local excision of the tumor. All of them had large tumors with a wide base of attachment. Their average age was 67 years and they have been observed for an average of 36 months. There were no deaths and no substantial complications except a fecal fistula in one patient that required a temporary colostomy. One patient had a local recurrence of the benign villous adenoma after 47 months. The technique of posterior resection is simple and well tolerated. Posterior resection should not be used for adenocarcinoma of the rectum of a more radical procedure is possible.


Metabolic intestinal surgery. Its complications and management. From November 1970 to August 1974 small intestinal bypass was performed in 475 patients for morbid obesity with an operative mortality of 1.6%. Immediate postoperative complications were superficial wound infection (17 patients), pulmonary complications (seven patients), cardiac complications (five patients), wound dehiscence (nine patients), intestinal tract fistula (four patients), and miscellaneous complications (14 patients). Delayed complications included hypokalemia (28%), hypocalcemia (9%), anemia (11%), calcium oxalate urinary calculi (6%), gout (2%), and hepatic failure (1.4%). Fourteen patients died of late complications. Ventral incisional hernia occurred in 3% of the patients; failure to lose sufficient weight in 21%, all but one occurring in patients with end-to-side shunts. Thirteen end-to-side shunts have been converted to end-to-end shunts because of insufficient weight loss. A team concept is important in the handling of the morbidly obese. Small bowel bypass is effective in producing sustained weight reduction in these patients. Careful and continued study of these patients for the rest of their lives is of paramount importance.


[Structure of the neurons of the spiral and vestibular ganglia and changes in them under conditions of adequate stimulation]. The ganglionic cells of the eighth nerve ganglia were studied. The cells of the vestibular and spiral ganglion were similar in structure. Changes in the ultrastructure involving the mitochondrial apparatus, and squamous endoplasmic reticulum and the nucleus took place in the ganglionic cells under effects of stimulation (sound, angular accelerations, vibration). These shifts appear to be morphological manifestations of the ganglionic cell metabolism under the influence of a specific stimulus.


[The state of the neural elements of the intestine in the aging organism]. The small intestine of the ageing human (15 cases from 70 to 88 years of age) and dogs (20 cases from 15 to 20 years of age) was treated by histological and neuro-histological methods. Vacuolic dystrophy of neurons and hyperplasia, thickening of their processes were found. Different formations up to 15 in number and from 20 to 60 mkm in size were revealed in the dog small intestine wall along the course of the nerve fibre. They were of pear-like, oval or round shape. Inside these formations sometimes there occur disfibration of neurofibrilles resulting in formation of structures which resemble incapsulated sensory apparatus. In the human small intestine the bodies and processes of neurons suffer most of all, while in the dog the nerve conductors do.


[The role of the buds and myoblasts in reparative regeneration of muscle fibers of the skeletal type]. The reparative regeneration of the tibial muscle of the frog was studied. Both light proper-muscular nuclei and dark subsarcolemmal ones (from the author's point of view--the nuclei of cells-satellites) take part in it. The former are not labelled with H-3-thymidine do not divide mitotically, do not incorporate H-3-uridine and multiply by fragmentation. During the latter they lyse. From them the end buds are formed which develop into "primary" myosymplasts. The second type nuclei, when secreting RNA and DNA, form myoblasts which divide mitotically. The primary myosymplasts serve as a framework along which the myoblasts move and participate in the myofibrilles formation. New muscle fibres develop through a confluence of myoblasts with one another, first forming sharply basophilic "secondary" myosymplasts on the surface of slightly basophilic "primary" ones. They become thicker through multiple deposition of joining myoblasts on the surface. The last of them remain isolated, apparently, in the role of new satellites.


[The histological structure of the adrenals in three species of desert rodents]. Distinctions of the histological structure of the adrenal gland are especially pronounced in the order of rodents where even the generally accepted scheme of the zonal nature of the adrenal cortex proves to be insufficient for description. Under study was the histological structure of the adrenal of the gopher Spermophilopsis leptodactylus L., jerboa Dipus sagitta Pall.  and gerbil Rhombomys opimus. The material of the study consisted of the adrenals of animals at different age and sex from the Kyzyl-Kum desert. The conditions of field collecting did not allow histochemical treatment of the material and only general histological analysis was undertaken. Characteristic features of the gopher adrenals are: a peculiar compression zone, absence of a pronounced juxtamedullary zone while a connective tissue layer being present between the cortex and medulla, availability in the medulla of one type of cells producing adrenaline. The adrenal of the jerboa is characterized by absence of a compression and a juxta-medullary zone, as well as of a connective tissue layer between the cortex and medulla, availability of two different types of cells in the medulla which produce different catecholamines. The adrenal of the gerbil is characterized  by a less, as compared with other rodents, lipid in the cortex, absence of a pronounced reticular zone and presence of two types of cells in the medulla.


[A morphofunctional analysis of the exocrine division of the pancreas subjected to disrupted innervation]. The functional state of the pancreas of the cat was studied light and electron microscopically 14 days after a removal of the solar plexus at different periods after feeding. It was established that disturbed innervation retained the capacity of the gland to respond to a food stimulus, but resulted in development of certain neurodystrophical changes in the organ which could be divided into two categories: 1) disorders observed permanently at both microscopic and submicroscopic levels and having degenerative character and involving an inconsiderable part of the organ. 2) Ultrastructural lesions involving more expansive zones of the organ parenchyma and developing in pancreacytes during their functioning. These processes did not result in  death of the gland cell but disturbed its normal secretory activity. Possible mechanisms of the found changes are discussed.


[Characteristics of the vascular-capillary network and the relationship between capillaries and cells in the nucleus of Luys in the cat during postnatal ontogenesis]. The development of the Luy's nucleus of the cat is not accomplished by birth-time. Complex relationships between nerve cell and capillaries continue to change during postnatal ontogenesis. The function of the Luy's nucleus becomes perfect by the third month. It should be noted that maturation of nerve cells and the vascular network goes not in parallel: the enlargement of the nerve cell occurs smoothly while the increase of the vascular-capillary network density is undulatory. There are three peaks in the development of vascular-capillary network: the 20th day, one month and a half, adult cat.


[Ultrastructural changes in the capillaries of the renal glomeruli and parenchyma following acute ischemia]. The ultrastructural changes of the capillaries of the renal glomerule and the parenchyma of the kidney were studied in 20 albino rats after clamping the vascular peduncle of the left kidney for 30 minutes, 1, 2 and 3 hours without a following recovery of the blood flow. In 30 minutes pinocytosis was increased in the cytoplasm of endothelial cells of glomerule capillaries. In the cytopodia there appeared vacuoles. The brush border was swallen, its separate growings acquired a bulb-like shape. Microplasmatosis of the internal plasmolemma of the endothelium appeared after 1--2--3-hour ischemia. The basal layer of capillaries became wider, with uneven contours and partly homogenized. Cytopodia became deformed and more close. The brush border was rejected in some places. Mitochondria were swallen, crists lost their parallelism, their amount became less.


[Morphofunctional characteristics of the microcirculatory bed of the cochlear portion of the otic labyrinth]. It has been shown that the microcirculatory system of the cohlear portion of the labyrinth is a complex of vessels adapted to the organ function. The analysis of the blood passages in the cochlear channel has shown that in accordance with the organ structure there occurs a spacious subdivision of the micrcirculatory bed into working units (segments) which are functionally integrated into a single microcirculatory system. Quantitative estimation of the microcirculatory system parameters has shown that 1) the blood volume which comes into the microcirculatory system is distributed between the vessels as following: 26%--arterioles: 8%--precapillaries; 29%--capillaries; 8%--postcapillaries and 29%--venules. 2) 639 capillaries fall on 1 mm-2 of the vascular strip and their diffuse surface is 1,3 mm-2.


[An roentgeno-anatomic study of intrafamilial similarities in the development of the human skeleton and soft tissues]. Correlation coefficients of the size of the hand bones and the thickness of soft tissues of the shoulder and forearm were calculated for different combinations of close relative pairs. The relation of the mother with children proved to be closer than that of the father. According to osteometrical signs of the hand the similarity in pairs father/daughter was more pronounced than in pairs father/son. A greater degree of relation in pairs father/son was characteristic of the thickness of soft tissues of the shoulder and forearm. The gonosomal inheritance of osteometrical signs and autosomal inheritance of the soft tissue development is suggested.


[The arterial bed of the spinal cord in newborn infants following segmental artery ligation]. The aim of the investigation was to find out the number of ligated segmental arteries which did not cause neurological spinal complications. The segmental arteries were ligated at different distances from the aorta and in different numbers. A unilateral ligation of 1--8 segmental arteries near their branching from the aorta did not result in alterations of the arterial bed of the spinal cord. A bilateral symmetrical ligation of 4--5 segmental arteries next to aorta caused a poor filling of root vessels. Uni- and bilateral ligations of 3--4 intercostal and lumbar arteries near the aorta and at the level of intervertebral foramens resulted in both root arteries and the anterior spinal artery being not filled with an opaque substance.


[Individual anatomic variability of the subthalamic nucleus in frontal sections]. The paper presents the results of studying individual variability of the shape, size and disposition of the subthalamic nucleus. Under investigation were 100 preparations. The structure was studied in serial frontal sections of the diencephalon and midbrain taken 1 mm apart. A considerable variability of the disposition of the subthalamic nucleus was revealed relative to intracerebral reference--points used in stereotaxic operations. The limits are outlined within which stereotaxical lesions should be avoided.


[The effect of training regimes on the vascular bed of the rabbit medulla, pons and midbrain]. The aim of the work was: 1) comparison of training results on two schedules of rotation and 2) establishment of the maximum period when the positive effect of the training was kept. The work was performed in 46 rabbits (42 of them were taken in experiments). All stresses were made in an electrocentrifuge with a 1 m radius. The blood vessels of the medulla oblongata, pons and midbrain studied by methods of injection and clearing of horizontal sections (120 mu) were taken as morphological control. It was shown that morphological control considerably confirms the picture of training of the organism to stresses. Schedule N2 (18 rotations without a preliminary limbering-up) proved to be more effective. The trained state of rabbits obtained in the process of training by this schedule retains for 3 weeks.


[Lens cell growth in tissue culture].

[Lens cell growth in tissue culture]. The epitheliomorphous zones of growth of piece explants of the mammalian embryonic lenses are comparable with those of neuroectodermal origin in formation of the rosette-shaped, perle-like and neuroretinal structures. They differ from the epidermal epithelia by absence of keratinization. The cambial and differentiated cells of the lens in the culture retained their specificity and differentiated. Comparison of the personal and literature data confirms N. G. Chlopin's idea of a necessary inclusion of the lens tissue in the group of tissues of the ependimo-glial type.


[Oncocytes--a system of serotoninocytes]. Oncocytes, irrespectes, irrespective of their localization in this or that organ, possess only one active function inherent in all cells of the given type; this function depends on serotonin cantained therein.  Consequently, oncocytes are not afunctional perishing cells, as was thought up to this time, but represent a group of serotoninocytes appearing in the form of a widely spread in the organism of the diffuse peripheral neuro-endocrine system, the activity of which is associated with the function of the givern biogenic monoamine.


[Renal dysplasias].

[Renal dysplasias]. The article presents an analysis of world literature on cysplasia of the kidneys (KD).  The authors consider as morphological characteristics the following signs: combination of primitive ducts, tubules, glomeruli, collecting tubules, cysts and immature mesenchyme with foci of cartilage and muscles.  An attempt is made to systematize individual forms of DK according to the degree of morphological changes (simple and cystic), extension (focal, segmental and total, mono- and bilateral) and localization (cortical, medullar and cortico-medullar or mixed) of the process.  From the group of cystic DK primary (aplastic and multicystic variants) and secondary (obstructive) ones were singled out.  The problems of morphology, incidence, complications, concomitant anomalies, causal and formal genesis of DK were also considered.


[The international classification of bone tumors and some remarks concerning it]. The international histological classification of bones has been issued by the World Health Organization in 1972.  The article discusses merits of the classification, its importance in unification of the nomenclature on bone tumours, in studies of their nature and histogenesis, etc.  At the same time some drawbacks of the classification are noted: lack of accuracy with respect to the nomenclature and grouping of the so-called giant-cell tumours of bones, with respect to the group of tumours of the "bone marrow", the group of mesenchymomas, etc.  The author makes his critical notes on the basis of the experience gained by his co-workers and by himself.


[The mitotic division of cardiac muscle cells]. A damage of the myocardium inflicted in the early post-natal period of the development of a rat, i. e. when there exists a high mitotic activity of the muscle cells of the heart, did not heal at the expense of filling of the focus of damage by newly formed muscular cells.  The myocardium of the auricles in adult animals does not possess any special capabilities for proliferation of muscular elements by means of mitosis, as compared with the myocardium of the ventricles.


[Histoenzymatic characteristics of fibroblasts during organization of myocardial micronecroses]. The activity of dehydrogenase of succinate, lactate, glutamate, malate (NAD- and NADP dependent), alpha-glycerophosphate (NAD-dependent), glucoso-6-phosphate, NAD- and NADP-dyaphorase was studied in adult and old rats with the help of histoenzymatic methods in normal cardiac fibroblasts and under conditions of reparative regeneration developing in the places of foci of myocardial micronecroses caused by administration of adrenaline.  Analysis of the activity of enzymes in normal fibroblasts revealed the predominance therein of an anaerobic way of metabolism.  In the process of reparative regeneration the level of metabolism of fibroblasts rose with inclusion of the acitvity of pentose shunt and Krebs' cycle.  No age differences in the activity of enzymes under study were revealed.  The data obtained are discussed in connection with the problem of ascertaining inter-enzymatic relationships ensuring metabolism of the connective tissue in the process of its maturation.


[The effect of duodenitis on the healing of chronic duodenal ulcers]. Dependence of healing of a chronic ulcer of the duodenum on structural changes of its mucosa was studied.  A total of 95 patients with ulcerated lesions localized in the duodenal bulb at the stage of exacerbation were examined.  Morphological changes were determined on the basis of the data of duodenoscopy and those of a histological investigation of the material obtained by the method of spot biopsy.  The majority of patients examined showed the presence of duodenitis of a various degree of manifestation and mostly in the duodenal bulb in the distance from the ulcer.  A clear-cut dependence of healing of ulcer on the presence and degree of gravity of changes in the duodenum was noted: in patients with unhealed ulcer duodenitis was more pronounced and persisted during the whole period of hospitalization of the patients despite the administered course of anti-ulcerous therapy.


[Alcoholic lesions of the liver (morphology and several questions concerning pathogenesis)]. On the basis of morphological studies of 130 puncture material of the liver in 100 patients with chronic alcoholism the three morphological forms of its lesion were identified: dystrophic changes in hepacytes; alcoholic hepatitis (acute and chronic); cirrhosis of the liver.  It is suggested that the morphological forms mentioned above represent the stages of one process--developing alcoholic hepatopathy.  Progressing of the process in the liver in chronic alcoholism is connected with necroses of hepacytes as a result of toxic effect of alcohol with a subsequent reaction of the cells of the portal stroma and sinusoids.  Gravity of lesions of the liver depends largerly on individual sensitivity to alcohol, one of the main factor of which may be the capacity of the liver to reproduce ADG.


[The role of several occupational factors in the development of pulmonary alveolar proteinosis (an experimental study)]. The article deals with results of morphological and electron-microscopy studies of the lungs in experimental pulmonary alveolar proteinosis in rats.  The disease was reproduced in experiments on 500 animals by means of chronic inhalation of electro-welding copper-containing aerosols, condensations (smokes) which may develop under similar concentrations during electric welding.  The lungs were investigated at intervals ranging from several days to two years from the beginning of the experiment, the duration of which was 9 months, the dayly exposure of the animals in inhalation cameras being three hours.  The intra-alveolar content was composed of products of accelerated life activity of the cells of the alveolar epithelium as well as of perished phagocytes (proteins, lipids).  The degree of manifestation of the process depended upon concentration of aerosol and duration of the experiment.  In the zones of pulmonary alveolar proteinosis there were observed thickenings of the basal membranes, sclerosis of interalveolar partitions, slow replacement of perished macrophages by new ones, which were the causes of prolonged resolution of the alveols content.  Pulmonary alveolar proteinosis (lipoproteinosis) should not be considered as a variety of pneumonia or edema of alveols.


[Clinico-morphologic characteristics of periodic disease]. The article deals with clinico-anatomical characteristics of two observations over periodical disease.  Peculiar features of the developing in this case of genetic amyloidosis, which is considered as a disease of accumulation, are analysed.


[Free cells of the connective tissue in pathological proliferation of the epithelium and in tumor growth]. The article presents a review of literature data and the authors' own investigations dealing with the dynamics of accumulation and distribution of free cells of the connective tissue in various forms of pathological proliferation of the epithelium (inflammatory overgrowth, disharmonal hyperplasia, tumours).  Despite the availability of numerous data on morphological characteristics and functional significance of free cells, there are no reliable data on regularities of accumulation and distribution of individual cellular forms depending upon the character of a pathological process, its localization and extent of changes in the parenchymatous elements of the organ.  But implementation of a local immunological control and maintenance of structural homeostasis should be linked first of all with reactions of free cells of the stroma.  Elucidation of the role of cellular reactions in the stroma of tumour formations is of importance for prognostic evaluation of a possible progression.  The authors showed that in experimental reproduction of disharmonal hyperplasia and tumours of the uterus and mammary gland there was a correlation between accumulation and distribution of eosinophilic leucocytes and plasmatic cells and the extent of changes in the epithelium.  The presence of the cells of the immunocompetent series may be considered as an evidence of immunological reactions occurring as a responce to changes in antigenic properties of the epithelium in the course of malignization.  The authors believe that knowledge of conjugated reactions of the stroma and epithelium in inflammatory, hormonal, and tumour growth may contribute to better understanding of the mechanisms of correlation of tissues in the course of a proliferative process and to ascertaining the causes of impairment of this correlation.


[Morphogenesis of congestive fibrosis of the liver]. Genesis of the muscatel-like fibrosis of the liver was studied on section and experimental material.  The methods of histological, histochemical and electron microscopy analysis were used.  It was established that the rise of pressure in the system of hepatic veins in chronic cardiac decompensation was accompanied by drastic venous congestion, hemorrhages and necrosis of hepacytes in the circumference of the central and collecting veins and along the lines of their junction which resulted in inversion of the hepatic lobes.  In the zones of venous congestion pericentral fibrosis developed, which occasionally may be accompanied by priportal fibrosis.  At later stages, muscatel-like cirrhosis of the liver was formed.  The latter was underlaid by an elevated tropocollagenous activity of cells, this activity apart from fibroplasts, may be fulfilled also by Dupffer's cells.  In chronic hepatic congestion a number of compensatory-adaptive changes in the vessels may occur.


[Elasticity of the lymphatic bed of the human esophageal wall in liver cirrhosis]. The maximal density of lymphatic capillaries in venous stasis was observed in persons of mature age and the minimal one--in elderly people.  In adolescents and young people the number of lymphatic capillaries under conditions of the said pathology was found to be increased.  The lymphatic bed of the oesophagus wall at early stages of the development of cirrhosis of the liver, apparently, ensured the outflow of the liquid from the organ tissues.  As the disease developed, transudation of the liquid from sanguiferous capillaries exceeded the transport possibilities of the lymphatic bed, which led to the development of dynamic insufficiency of the lymphatic system.


[Effect of experimental inflammation of the appendix on immunogenesis]. Effects of an operation trauma and inflammation of the appendix caused by ligation of appendicular vessels on immunogenesis were studied in experiment on rabbits.  A number of antibody-containing cells of plasmatic series in the blood serum and their percentage interrelation in the appendices were determined.  A stimulating effect of laparotomy on the quantitative content of antibodies in the blood was established.  Accelerated differentiation and restitution of the percentage interrelationship of antibody-containing cells in the appendix were noted at earlier periods as compared with controls in which similar phenomena were observed at later terms.  The development of inflammation in the appendix in the majority of animals revealed itself in an increase of the antibody content in the blood at earlier periods and a decrease thereof at later periods.  In the appendix the accelerated differentiation at earlier periods wes not completed subsequently by restitution of the percentage interrelationship of antibody-containing cellular forms.


[Pathomorphology of experimental chronic skin ulcers]. Dynamics of morphological and some histochemical changes was shown on an experimental model of chronic ulcer of the skin (25 guinea-pigs).  On the previously epilated and scaridied skin of animals consisting of 4 groups (5 animals in each group) applications of "chromin alkali" with various concentrations of bichromates of potassium and sodium were made; biopsy specimens were taken at 1, 4, 7, 10, 15, 20, 25, and 30 days.  The results obtained made it possible to identify 4 stages in the development of chromic ulcer (prenecrotic, necrotic, chromic ulcer, healing), each stage being characterized by its own peculiar features of the clinical course and morphological changes.


[Cytoplasmic cross links of erythrocytes (observations in scanning electron microscopy)]. Erthyrocytes can form cytoplasmatic bridged connecting with each other individual cells or a great number of cells into a conglomerate.  The cytoplasmatic bridges--is a peculiar form of existance of erythrocytes which differ from the forms described earlier: thorm-like (spheroechinocytes) and myelino-like forms having nothing in common with the mechanism of agglutination.  The cytoplasmatic bridges of erythrocytes were found in man, dogs and guinea-pigs irrespective of a disease or conditions of an experiment, i.e. they may be referred to as a common biological system.  The cytoplasmatic bridges may desintegrate, i.e. to be subjected to reverse development, which in a overwhelming majority of cases, as well as their formation, does not effect materiality the size and form of red corpuscles.  Erythrocytes are united by means of cytoplasmatic bridges only with erthrocytes (predominantly with young ones) and never with any other cells of the blood.


Cerebellar infarction. A clinicopathological study. The clinical and pathological features of 28 fatal cases of acute uncomplicated massive cerebellar infarction are reviewed. Although infarcts may involve any portion of the cerebellum, they predominantly involve the posteroinferior half of one cerebellar hemisphere. The frequency of acute uncomplicated fatal cerebellar infarction is much greater than previously appreciated, approximating that of acute fatal cerebellar hemorrhage. All patients were past middle age. Atherosclerosis and acute vertebral artery occlusion were the most common etiological factors. The onset was sudden in most cases, with vomiting, dizziness, vertigo, and cerebellar dysfunction. All patients died with progressive brain stem dysfunction and medullary respiratory failure secondary to compression by a swollen cerebellum. Death usually occurred between the third and sixth days following the onset of symptoms, but only six to 30 hours after the onset of obtundation; therefore, decompressive therapy must be instituted promptly.


Acute cerebellar infarction in the PICA territory. Although old or recent infarcts of a cerebellar hemisphere in the territories of the posterior inferior (PICA), superior, or anterior inferior cerebellar arteries are commonplace autopsy findings, in no case have corresponding clinical symptoms been clearly identified. We have studied three cases, two clinocaopthologically and one clinicosurgically, in which an acute infarct involving only the cerebellum lay in the PICA territory distal to the branches to the medulla oblongata. The clinical manifestations consisted of rotatory dizziness intensified by motion, nausea, vomiting, imbalance, and nystagmus. In two cases, the clinical diagnosis had been a benign labyrinthine disorder. Recognition of a syndrome corresponding to cerebellar infarction in the PICA territory is important insofar as it assists in the differential diagnosis of dizziness. It becomes of crucial importance when cerebellar infarction is the prelude to cerebellar swelling and brain stem conpression leading to coma and death unless surgically relieved.


Hypocapnia and intracranial volume-pressure relationship. A clinical and experimental study. The effect of induced hypocapnia was observed, during intraventricular pressure monitoring, in five patients with chronically increased intracranial pressure (ICP) and in five baboons with acutely raised ICP. The volume-pressure response (VPR) was used as a measure of intracranial elastance (inverse compliance), an index of residual compensatory capacity. The VPR is the acute increase in mean ICP that occurs in response to a constant volume increment to ventricular cerebrospinal fluid. In the patients, hypocapnia produced a decrease in the VPR that was proportional to the decrease in ICP; in the baboons, ICP was substantially decreased with minimal change in the VPR. Both observations indicate that hypocapnia, though it decreases ICP, does not selectively decrease intracranial elastance. This may be a limiting factor in the use of hypocapnia in the management of raised ICP.


No-flow state following cerebral ischemia. Role of increase in potassium concentration in brain interstitial fluid. Rats were subjected to total cerebral ischemia by occluding outflow from the heart. In control experiments and following different periods of ischemia, potassium concentration was measured in cisternal cerebrospinal fluid (CSF). It rose to 19.4 mEq/liter following 16 minutes of ischemia. Changes in cerebrovascular resistance (CVR) were also assessed by measuring the cerebral perfusion rate (CPR). Following two minutes of ischemia, CVR was decreased to half control value. After 8 and 16 minutes of ischemia, CVR was markedly increased, and "no-flow" state was approached after 16 minutes of ischemia. The CVR increased concomitantly with increase in potassium concentration in cisternal CSF. We suggest that the increase in CVR following cerebral ischemia is due to increase in potassium concentration in brain extracellular fluid and is part of a vicious circle that leads to brain death.


The Dandy-Walker and Arnold-Chiari malformations. Clinical, developmental, and teratological considerations. Five patients with the Dandy-Walker syndrome had dysgenesis of the cerebellar vermis, cystic dilatation of the fourth ventricle, and a high position of the tentorium cerebelli. When only these features are present, the patient may lead a normal life. Additional defects usually account for the prominent clinical and pathological features of this syndrome. In this series, one patient had aqueductal stenosis, four had agenesis of the corpus callosum, two had hydrocephalus, one had cerebral abiotrophy, and one (a 72-year-old man) had no additional defects and no symptoms from his Dandy-Walker syndrome. An analysis of development and teratological considerations indicates that the Dandy-Walker and Arnold-Chiari malformations are complex disorders that have different causes and mechanisms and begin at different times in the emryonic period. The causes are still unknown.


Appparent familial multiple sclerosis in three generations. Report of a family with histocompatibility antigen typing. Three members of an unusual family were affected with apparent multiple sclerosis in a direct line over three successive generations. Each affected member had clinical remissions and exacerbations and evidence of lesions disseminated in space. One affected member had a cerebrospinal fluid pleocytosis and elevated gamma-globulin level. The genetically determined histocompatibility antigen (HL-A) types are reported for 13 family members. The three affected members had HL-A types 11 and W16 in common.


Retinal changes in Himalayan climbers.

Retinal changes in Himalayan climbers. Changes in the fundus of the eye were studied in 15 members of a mountaineering expedition to Dhaulagiri, Nepal (elevation, 8,167 meters [26,795 ft]). Retinal photographs were taken at sea level and at 5,883 meters (19,300) after each climber had descended from his highest point. Five Nepali Sherpas and an additional American climber who came to the base camp late in the climb were also studied. Vascular engorgement with tortuosity, a 24% increase in arterial diameter, and a 23% increase in venous diameter were observed. Retinal hemorrhages were seen in five American climbers (33%), but in none of the Sherpas. The high incidence is striking, but the cause is unknown. We suggest that the hypoxic vasodilatation makes retinal vessels more vulnerable to sudden rises in intravascular pressure.


High altitude retinal hemorrhage.

High altitude retinal hemorrhage. The accessibility of high-altitude areas presents the risk of high altitude retinal hemorrhages (HARH). Four cases reported illustrate localized macular, diffuse, and familial incidence of HARH. Fluorescein angiography indicated no leakage, and a superficial retinal location of the hemorrhages. Marked retinal artery and vein dilation occurs. Ophthalmodynamometry showed retinal vascular hypertension in the presence of HARH. The complete resolution of hemorrhages occurs in most cases. Despite the return of visual acuity to normal, visual function studies indicate the persistance of defects.


High altitude retinopathy in mountain climbers. Retinal hemorrhages appear to be a frequent, though often unappreciated, occurrence in unacclimated climbers experiencing prolonged exposure to altitudes above approximately 3,658 meters (12,000 ft), heights frequently attained by American moutaineers. This condition has not received attention in the ophthalmologic literature, though several reports of retinal and vitreous hemorrhages have appeared in nonophthalmologic journals. Of six surviving members of a climbing expedition of Mt. Aconcagua, four had retinal hemorrhages. Two had permanently disturbed vision with paracentral scotomas plotted on a tangent screen.


The visual field and nerve head in angle-closure glaucoma. A comparison of the effects of acute and chronic angle closure. Eighteen unilaterally affected acute angle-closure glaucoma patients were seen a period of time after the acute episode, and 11 unilateral chronic angle-closure patients were seen while under control. Visual fields, optic nerve heads, and vision were assessed using the normal eye as a control. Nerve fiber bundle defects were seen in seven of the acute and nine of the chronic angle-closure cases. None of the acute, but five of the chronic angle-closure patients, showed asymmetry of cupping, while pallor was seen in seven of the acute and nine of the chronic patients. No significant difference in reduction of vision was seen between the two groups. The duration of pressure is a possible reason for cupping in glaucoma.


Cycloplegics and mydriatics. Tolerance, habituation, and addiction to topical administration. A patient had tolerance, habituation, and addiction to the topical use of a combination of cyclopentolate hydrochloride and tropicamide. He also developed a blotchy, diffuse epithelial keratitis that disappeared when the drugs were discontinued.


Penetration of fluorometholone into the cornea and aqueous humor. In each of the experimental conditions studied, fluorometholone penetrated into the cornea and aqueous humor following topical administration of a standard drop. The amount of drug measured in each location was less than that previously documented for dexamethasone and prednisolone preparations. In contrast to these more conventional steroids, the ocular penetration of fluorometholone appeared to be unaffected by the presence or absence of the corneal epithelium or of intraocular inflammation.


Scleral bursting strength. Results after treatment with ruby laser, cryotherapy, or diathermy. A study has been performed testing the relative bursting strength of sclera in rabbits treated with diathermy, cryotherapy, or ruby laser energy. Neither the cryotherapy nor laser appeared to weaken the strength of sclera, whereas the diathermy appeared to cause an appreciable loss of scleral bursting strength.


Mastoid Obliteration. Histopathologucal Study of Three Temporal Bones. Three temporal bones were serially sectioned to study the postoperative fate of the meatally based postauricular musculoperiosteal flap. In all three ears, the flap sealed off the middle ear effectively from the mastoid cavity and in one, with resected canal wall, formed a new soft posterior wall with good meatus. All flaps contained viable muscle, fat, collagen, reticulin, and elastin, and were richly vascularized. In two flaps, small granulating foci of infection were noted. In two temporal bones, from a child with hypogammaglobulinemia, small cholesterol cysts formed behind the falp during the delayed healing of the mastoid wounds.


Schirmer test of lacrimation. Its clinical importance. Lacrimation was tested by a modified Schrimer test, ie, by the soaking of strips of filter paper hooked into th lower conjunctival sac. The test is advocated for the topical diagnosis of facial-nerve lesions. Lacrimation was found to be independent of age and sex. There were, however, large inter- and intra-subject variations. Nevertheless, the difference between the two eyes of a given healthy person was much less than that between the eyes of two different persons, making the test clinically useful. In a given patient, a bilateral difference may be assumed to be significant when the lesser value does not exceed 27% of the larger one. Such a test result is indicative of a supraganglionic facial-nerve lesion.


Acousticofacial anastomoses in Meniere disorder. It is possible that acute labyrinthine hydrops characteristic of Meniere disorder is related to hyperparasympathetic tone analogous to that observe in rhinorrhea or nasal congestion. This new hypothesis is is supported by anatomical, clinical, and surgical arguments. Anatomically, the ear is supplied by a parasympathetic pathway from the acousticofacial anastomoses of Wrisberg intermediate nerve and the vestibular nerve. These anastomoses are of great importance and appear at a very early stage of embryonal development, much earlier than other parts of the parasympathetic component of the facial nerve. Surgically, vestibular neurectomy via the middle fossa route conserves the anatomy of the inner ear. Together with the vestibular nerve, the acousticofacial anastomoses are removed. This operation results in an improvement of hearing that is far from negligible.


Surface-active agent in Eustachian Tube Function. Using 15 fresh guinea pig temporal bones, Eustachian tubal function was tested repeatedly before and after saline washing to demonstrate the effect of surface-active agent. Although tubal opening pressures for the 15 ears varied considerably, in each ear tested, a higher pressure was required to open the Eustachian tube after saline washing (P less than .001). A significant statistical difference in Eustachian tube opening pressure was also found between consecutive trials before washing the Eustachian tube with saline (P less than .001). This phenomenon disappeared after saline washing. It is possible that these phenomena occurred as a result of surface-active agent (surfactant) functioning in the Eustachian tube.


Directional microphone in hearing aids. Effects on speech discrimination in noise. This study was designed to investigate the amount of directionality among three directional aids of different brands and to compare speech discrimination ability of hearing-impaired persons using directional and nondirectional hearing aids in competing background noise. For each hearing aid under study, the full-on gain curves were obtained at 45, 135, 225,, and 315 degree azimuths in an anechoic chamber. Thirty-two hearing aid users were included. Discrimination ability was assessed, using commercially available W-22 disc recordings. Findings indicate directionality varies among directioalaids. The hearing aid that shows the greatest directional effect was found to provide the listeners with best speech discrimination ability under relatively difficult listening conditions. However, it is inadvisable to recommend just any directional aid without careful evaluation of its directional capability under competing noise.


A method of stapedectomy in the fenestrated ear. Two consequences of a previous fenestration militate against successful stapledectomy. They are the lessened depth of the middle ear over the stapes, and the missing incus. Twelve years' experience of using the stapedectomy for fenestrated ears in 62 patients has given generally disappointing results until, in 1962, technique of using cartilage blocks to increase the depth of the middle ear was devised.


Parapharyngeal rhabdomyoma.

Parapharyngeal rhabdomyoma. Rhabdomyoma is a benign tumor of striated muscle origin that is very rare in young children. Review of the world literature revealed 20 cases of extracardiac adult-type rhabdomyoma in the head and neck area. All reported cases have been encapsulated and easily excised. A 22 1/2-month-old girl with a parapharyngeal rhabdomyoma is unique in that her tumor had atypical histology and lacked a capsule; it could not be "shelled-out".


Aberrant course of the facial nerve.

Aberrant course of the facial nerve. In our patient the facial nerve was situated in the external bony ear canal without bony protection just below the skin in the lower part of the external ear canal 2 to 3 mm lateral to the tympanic membrane. This abnormal position involves a greate risk of damage to the facial nerve by incisions in the ear canal prior to surgical intervention of the middle ear.


Recovery of crossed acoustic reflexes in brain stem auditory disorder. Crossed acoustic reflexes were serially monitored in a patient receiving radiotherapy for an intra-axial brain stem tumor. Analysis revealed a pattern of systematic recovery as the brain stem lesion responded to therapy. Crossed reflexes were observed at more and more test frequencies, until responses were present on both ears for all test signals. Pure-tone sensitivity and speech intelligibility remained within the normal range throughout the observation period.


Benign congential neoplasms: dermoids and teratomas. Congential tumors in the head and neck are usually benign dermoids or teratomas. These rare neoplasms are first noticed in neonates or infants and frequently rapid diagnosis and treatment may be lifesaving. Since they are rare tumors periodic case reports are worthwhile to remind us to include them in our differential diagnosis.


Diagnostic value of meatocisternography. Based on a review of 123 consecutive examinations a classification of ten types of meatocisternograms is proposed. Surgical correlation in 53 of these cases has shown that other causes of intrameatal filling defects may mimic acoustic neurinoma presence. Furthermore, grouping of these 123 patients into three clinical groups on the basis of symptoms and findings has not resulted in a clear type correlation when using a mixture of the ethyl esters of 9- and 10- monoiodostearates (Duroliopaque). Based on an experience using this classification in well over 500 meatocisternograms, several proposals are made for the clinical management of cases of clear-cut or suspect acoustic neurinomas.


Middle ear reflex activity in the startle reaction. By means of extratympanic phonometry, the middle ear muscular reflex activity in the startle reaction was measured in a control series, in patients with otosclerosis and in patients with operation cavaties without a functioning tensor tympani muscle. In comparison with the stapedius reflex, the startle reflex was found to be much more variable regarding latency, amplitude, and configuration. It was characterized by pronounced fatigue and a high alertness dependence. The period of latency was about 60 msec. It was possible to elicit a distinct startle reflex in operation cavities without a functioning tensor tympani muscle, probably because of contraction of the Eustachian tube muscles.


Spontaneous nystagmus direction does not indicate laterality. There have been conflicting statements made in the literature on electronystagmograms (ENG) concerning the direction of beating of spontaneous nystagmus in the presence of a damaged labyrinth. This report presents a retrospective examination of 1,220 ENGs done at Stanford over the past four years with regard to the direction of spontaneous nystagmus and the side of the diseased labyrinth. The diseased labyrinth is indicated by a hypoactive caloric response. The study showed that one cannot predict the side of the labyrinthine lesion from the direction of beating of the spontaneous nystagmus.


Rheumatoid nodules of the larynx.

Rheumatoid nodules of the larynx. The clinical presentation and histologic appearance of three cases of laryngeal rheumatoid nodules are the subject of this report. In one of these cases, the lesions differed from the classic appearance of the rheumatoid nodule in that they were strongly reminiscent of granulation tissue or a pyogenic granuloma. These vascular lesions are interpreted as immature rheumatoid nodules. Although there are no clinical clues that would lead to the preoperative diagnosis of rheumatoid nodule of the vocal cord and larynx, the index of suspicion should be high in patients with rheumatoid arthritis who are hoarse. However, overt joint symptoms do not appear to be a necessary concomitant of these lesions.


Personality characteristics in patients with vertigo. The role of emotional factors in patients with vertigo has been widely debated. Patients with vertigo, as well as patients in two separate control groups, were tested with the Eysenck Personality Inventory (EPI), the Cornell Medical Index (CMI), and a questionarie designed to evaluate the severity of the patients symptoms in order to further investigate the role of personality and its relationship to the symptom of vertigo. In patients with Meniere disease, a strong positive correlation was found between the severity of vertigo and the EPI and CMI scores. The concept of the psychological vulnerability" is useful in explaining these findings.


Bekesy test results in patients with eighth-nerve lesions. Forward reverse- and fixed-frequency tracings. Sweep-frequency Bekesy tracings, both forward (low to high frequency) and reverse (high to low frequency), as well as fixed-frequency tracings, were obtained from 18 patients who had eighth-nerve tumors (subsequently confirmed surgically). In general, reverse-sweep frequency tracings revealed greater adaptation for continuous tone stimuli than did forward-sweep frequency tracings. However, if a search for excess adaptation (greater than 20 dB) is the sole purpose for administering Bekesy audiometry to a given patient, then fixed-frequency tracings yield adequate differential information.


Middle ear function in neonates.

Middle ear function in neonates. This study was designed to investigate the middle ear function of neonates during the first few hours of life. Twenty normal babies, ranging in age from 2.5 to 20 hours old, were tested witn an electroacoustic impedance bridge. Measurements of the acoustic compliance of the tympanic membrane and tympanometry were obtained on both ears of each child. Results of compliance measurements indicated a median of 1,2 cu cm with a range of 0.25 to 1.65 cucm. Tympanometry results showed smooth notched-shaped tympanograms in most cases although afew M-shaped tympanograms were observed. All of the infants demonstrated normal middle ear pressures and mobile middle ear systems. The finding of normal middle ear function in these neonates suggest that mucus is not commonly present and therefore not a factor in infants' response to sound.


Dichotic pursuit auditory tracking after anterior temporal lobectomy. Patients with left or right anterior temporal lobectomies show severe deficits on the ear contralateral to the lesion in responding to dichotic speech stimuli. One patient with a left and one with a right anterior temporal lobectomy were tested on a dichotic pursuit auditory tracking task. There were no severe performance deficits that would have indicated difficulty in processing either pure tone stimulus; The resected areas were apparently not necessary for relatively efficient processing of these simple nonspeech stimuli, either because other parts of the damaged hemisphere were sufficient for task performance or because ipsilateral auditory transmission pathways can be used in this task. Both patients showed a speech-related right ear advantage for the jaw generated tone but not for the hand generated tone.


Subglottic hemorrhage following translaryngeal needle aspiration. Report of a case. A patient experienced an acute, brisk, endolaryngeal hemorrhage following an attempt at translaryngeal aspiration of tracheobronchial secretions. The bleeding was probably due to injury of the perforating branch of the cricothyroid artery or vein. The hemorrhage was controlled by a subglottic pack and tracheostomy.


Pneumocele of the maxillary sinus. A second case report. The term pneumocele refers to an expansile bone destructive air containing cyst-like lesion involving the sinus cavity proper, presumably due to obstruction of the major sinus ostium. It differs from pneumoceles described previously that have all been air pockets beyond a paranasal air sinus due to an abnormal fistulous communication, rather than expansion of the sinus cavity itself. In adding this second case to the literature we believe that this rare lesion may be encountered from time to time, and should be considered when an expanded maxillary antrum is found to contain air rather than fluid or soft tissue content.


Rectal biopsy in clindamycin-associated colitis. An analysis of 23 cases. The findings on rectal biopsy and proctoscopic examination in 23 cases of clindamycin-associated pseudomembranous colitis are summarized. On proctoscopic examination, discrete 2- to 5-mm raised plaques are seen adherent ot an edematous, friable mucosa. Rectal biopsy shows pseudomembrane formation and inflammation of the underlying rectal mucosa. Necrosis of the surface epithelium is a frequent finding; however, true ulcers were not observed. Vasculitis or thrombosis is not a feature of any of the cases. Frequently, the pseudomembrane is observed to be dislodged from the mucosal surface. In five of 23 cases, characteristic pseudomembranes are not present in the biopsy specimen in spite of the fact that they are evident proctoscopically.


Rytand-Lipsitch syndrome.

Rytand-Lipsitch syndrome. An 84-year-old woman had Rytand-Lipsitch syndrome, ie, total atrioventricular block resulting from destruction of the central areas of the conducting system due to extension of calcification from the fibrous ring of the mitral valve. In a postmortem coronary arteriographic study of 500 hearts, degenerative calcification of the fibrous ring of the mitral valve was demonstrated in 4.4% (95% confidence limits--2.8% to 6.6%), rheumatic valvular changes not being included. There were significantly more women than men with calcification of the mitral valve apparatus (P less than .00005). Division of the material into two groups larger than or equal to 70 years and less than 70 years showed a statistically significant sex difference in the former group (P les than .005), whereas the sex difference was of borderline significance in the latter group (.1 greater than P greater than .05).


Multiple primary tumors. Four distinct head and neck tumors. The case history of a 70-year-old woman with the simultaneous occurrence of mucoepidermoid carcinoma of the parotid gland, thyroid carcinoma, squamous cell carcinoma of the oral cavity, and a Warthin tumor is described. The simultaneous occurrence of three histologically distinct malignant tumors is a rare event amounting to approximately 1% of cases of multiple primary tumors. This case is unusual in that the tumors occurred in three separate organs and in association with a papillary cystadenoma lymphomatosum. While difficult to evaluate, prognosis and treatment should be approached with respect to each of the tumors as individual entities.


Sarcoid granulomas in CBA/J mice. Histologic response after inoculation with sarcoid and nonsarcoid tissue homogenates. Homogenates of lymph node and skin biopsy specimens and lymphocyte suspensions from patients with sarcoidosis and control subjects were injected into the footpads of CBA/J mice; histologic response was examined at intervals of 15 to 360 days. Kveim tests and complete autopsies were performed on animals of each group. Granulomas or equivocal granulomas were observed in 14.8% of biopsy specimens from animals that received sarcoid tissue homogenates and in 14.8% of control animals. No granulomas were observed after injection of lymphocytes from patients with sarcoidosis or from control subjects. Kveim tests were negative in all animals and autopsies were unremarkable. These studies fail to confirm previous reports of a "transmissible agent" in sarcoidosis and demonstrate that by the use of these techniques, such an agent is not invariably present in sarcoid granulomas.


Vascular ("arteriovenous") malformations of the choroid plexus. Two cases of arteriovenous malformation of the choroid plexus are presented, bringing the number of such cases reported to 16. One of these was successfully removed surgically after two episodes of intraventricular hemorrhage. The other was found incidently at autopsy and had produced an asymmetric hydrocephalus. Overproduction with a more forceful propulsion of cerebrospinal fluid may be the mechanism producing this effect. These lesions should be considered in cases of unexplained intraventricular hemorrhage.


Electrocochleography during noise-induced temporary threshold shifts. The responses of the auditory nerve and brain stem auditory nuclei were recorded non-traumatically in human subjects by means of electrocochleography before, during and after exposure to white noise intensities which produced temporary threshold shifts. The largest decrement (amplitude decrease and latency increase) was seen in the response of the auditory nerve. Large intersubject variability was seen in the effects of the noise exposure on response amplitude, latency and recovery rates.


Physical and auditory specifications of third-octave clicks. Physical: measurements of third-octave clicks (produced by ringing a commercial third-octave filter having a rejection rate of 50 dB in the first octave) show that waveform and spectral shape of the clicks remain the same through the range of audiometric frequencies. Auditory: relations between click and tonal thresholds are developed by (a) comparing click and tone thresholds at a repetition rate of 5/sec and (b) determining changes in click threshold for a range of repetition rates between 1 and 10/sec. Tonal thresholds are about 10 dB more sensitive at the 5/sec rate; a click repetition of 10/sec lowers the threshold, reducing the difference between tone and click audibility, while a repetition rate of 1/sec raises click threshold and increases the difference.


Pure tone audiometry in noise with auraldomes. Pure tone thresholds were obtained using a TDH-39 driver mounted in a standard (MX-41/AR) cushion and an Auraldome (AR-100-R) circumaural enclosure. Thresholds were recorded in quiet and in the presence of broad band sound field noise at 50, 60, and 70 dB SPL. No significant differences were observed between the two earphone conditions in the presence of any of the ambient broad band noise levels. However, thresholds were found to be statistically different in the quiet condition. These results raise questions regarding the calibration of intensity for Auraldomes and indicate that this particular circumaural cushion provides no advantage over standard cushions in the presence of ambient noise above 50 dB SPL.


White noise as a pretest sensitizer for neonatal hearing screening. To determine the effects of white noise as a pretest sensitizer in neonatal hearing screening, 450 neonates were tested under 18 test conditions which also permitted examination of infant state and criterion stimuli (warble tone versus narrow band noise) as variables. There were three pretest conditions: No pretest sensitizer; 90 dB pretest sensitizer, and 100 dB pretest sensitizer. Each pretest condition was followed by either a 90 or a 100 dB criterion stimulus. Analysis concerned an increase in the number and in the strength of the responses. Generally, there was no benefit associated with the use of white noise as a pretest sensitizer.


Paradoxical compliances in otosclerosis. Results of impedancemetry have been compared with operative findings in 1 867 cases of otosclerosis, 1 583 of which were pure otosclerosis. This comparison indicated that: (1) with present techniques, the results of impedancemetry are only of a relative value in otosclerosis; it is thus necessary to asses the various connected anatomical elements in the middle ear with extreme rigor; (2) impedancemetry data have an absolute value in all disorders of the middle ear with closed eardrum associated with otosclerosis; (3) relative impedancemetry often gives informative results when it concurs with the other elements of clinical and audiometrical diagnosis; (4) impedancemetry data are a valuable element of early diagnosis of otosclerosis before the first audiometric expression, either by a lowering of compliance or, most of all, by appearance of an on-off effect (diphasic impedance change) or by disappearance of the stapedius reflex; (5) parallel or crossed paradoxical compliances are only apparently paradoxical and are usually the sign of either an early stapedo-vestibular fixation (before its audiometric expression) or an associated factor in the middle ear, both of which may have been unnoticed; (6) the problem of compliance value in otosclerosis will be solved only when the proper stapes frequency is found and when it is possible to test this frequency. This problem is the subject of our current research.


Some effects of prestimulus activity and length of prestimulus observation judgements of infants' auditory behaviour. The auditory responses of nine 6-week-old and ten 6-month-old infants were assessed subjectively by a group of four observers. These responses were evaluated as a function of (1) prestimulus activity level and (2) duration of prestimulus observation. Response assessment for both ages was significantly affected by the first but not by the second. The percentage of responses for both ages tended to decrease with increasing prestimulus activity state. The findings are compared with the similar study of Langford et al. [1974] on neonates.


Ototoxicity with children caused by streptomycin. In the hospital for pulmonary tuberculosis in children, a group of 975 children treated with streptomycin sulphate was audiologically examined and in 36% of children ototoxic lesions were defined. From these, in 24% the damage affected only the vestibular labyrinth, in 8% both the vestibular labyrinth and the organ of Corti and in 4% the organ of Corti alone.


+Gz tolerance in man after 14-day bedrest periods with isometric and isotonic exercise conditioning. The purpose of this study was to determine the effects of isometric or isotonic exercise training on post-bedrest +Gz tolerance. Seven male volunteers, 19-22 years, underwent accelerations of +2.1 Gz (740 s), +3.2 Gz (327 s), and +3.8 Gz (312 s) in a selected, randomized order; the ramp to peak acceleration was 1.8 G/min. The centrifugation runs were terminated by loss of central vision (blackout) to a white light with a luminance of 3.15 times 10-5 log candle/cm-2 (0.092 ft-lambert). The study began with a 14-d ambulatory control period, followed by three 14-d bedrest periods (each separated by a 21-d recovery period) and then a final week of recovery. During the ambulatory periods, the subjects exercised on a bicycle ergometer at 50% of their maximal oxygen uptake (max VO2) for 1 h/d. During two of the three bedrest periods, the subjects performed in the supine position one of two routines, either isometric exercise (21% of max leg extension force for 1 min followed by 1-min rest) or isotonic exercise (68% of max VO2) for 0.5 in the morning and afternoon. During the third bedrest period, no exercise was performed. In general +Gz tolerance was reduced by 24% to 35% (p less than or equal to 0.05) after bedrest. Compared with control values, there were significant reductions in average tolerance times after bedrest with no exercise and isotonic exercise at all G levels. With isometric exercise, there was a significant decrease in tolerance at 2.1 Gz but not at 3.2 Gz or 3.8 Gz, even though the latter tolerances were reduced 15.6% and 10.0%, respectively. Both exercise regimens maintained tolerance at levels equal to or above that obtained with no exercise. Compared with control values, average tolerances were lower (p less than or equal to 0.05) after the two recovery periods between the bedrest periods (minus 24% to minus 26% at 3.2 Gz and 3.8 Gz), indicating that 3 weeks of ambulation was not sufficient time for full recovery from the deconditioning induced in this study. A prediction equation was constructed with data from all comparable studies utilizing deconditioned men riding relaxed without protective garments: Tolerance (in seconds) equals minus 334 + (1715/+Gz level). From this equation, the calculated tolerance after bedrest is 13.5 min at 1.5 G, and the point of zero tolerance is 5.1 Gz.


Responses to speech audiometry and phonemic discrimination patterns in the elderly. A new approach to the assessment of the hearing of speech has been used with a group of the elderly and certain phonemic discrimination difficulties accompanying the ageing process have been examined by both conventional and automated testing systems. The results from both these test systems are displayed in directed graph form and these digraphs (directed graph) show marked asymmetry in both young and old. This datum differs in its symmetry aspects from classical confusion studies; reasons for this are discussed. Some evidence is produced which suggests that accompanying the ageing process in some individuals is a reduction in the number or availability of phoneme categories which they can handle.


Extra- and intra-axial brain stem auditory disorders. Auditory symptoms of brain stem disorder depend on the nature of the lesion. This study compared auditory test results in 28 patients with extra-axial, 11 patients with intra-axial, and 6 patients with combined extra-axial and intra-axial brain stem disorders. Patients with extra-axial lesions usually demonstrated (1) sensitivity loss, (2) marked adaptation on Békésy audiometry, (3) impairment in PBmax scores, and (4) auditory symptoms on the ear ipsilateral to the radiographic abnormality. Patients with intra-axial brain stem lesions usually showed (1) slight, if any, sensitivity loss, (2) normal Békésy audiograms, (3) relatively good PBmax scores, and (4) suditory symptoms on both ears or on the ear contralateral to the radiographic disorders. In the patients with combined extra-axial and intra-axial disorders, auditory findings varied in relation to the extent of extra-axial involvement.