Value of the erythrocyte sedimentation rate in gynecologic infections. The ESR remains a valuable test in gynecology, specifically when obtained sequentially in cases of pelvic infection. It is nonspecific but has much merit in assessing prognosis and therapeutic measures. In conjunction with laparoscopy and diagnostic ultrasound it plays an important part in the evaluation of abdominal and pelvic infections.


Accurate roentgenographic determination of lumbar flexion-extension. Although many techniques have been devised for the roentgenographic measurement for angular motion in the lumbar spine, all present technical and visual problems. No previously described method has been subjected to a test of accuracy or reliability. A transparent plastic sheet technique provides a reproducible and accurate method for quantitative evaluation of flexion-extension motion in the lumbar spine.


Isolated lumbar disk resorption as a cause of nerve root canal stenosis. In established isolated disk resorption at the lumbo-sacral junction, nerve root canal stenosis affects predominantly the S1 nerve which becomes obstructed between the inner margin of the superior facet of S1 and the buckled ligamentum flavum behind and by the ridge of the remaining annular fibers in front. However, in addition, there may also be an intervertebral foramen stenosis involving the L5 nerve at this level. Accordingly, in planning the surgical treatment of this condition where bilateral buttock and leg pain has become intractable or frequently recurrent, and where back pain is not major concomitant of the symptom complex, the surgeon must remove the inner and superior margins of the S1 facet together with the whole of the ligamentum flavum, thereby decompressing both L5 and S1 nerve roots. The operation involves a partial facetectomy only at the affected level and spinal stability is not impaired.


Stenosis of the lumbar spine in spondylolisthesis. There are three factors which determine the volume of the spinal canal, its lateral recesses and the intervertebral canals; the developmental size; the level cephalad and caudad of the vertebral column; the multiple acquired conditions which may cause encroachment. The causes of narrowing in spondylolisthesis are characteristic of each type. Three common groups are mentioned, congenital, isthmic and degenerative and the nature of obstruction and its appropriate treatment is described in each case.


Spinal stenosis. Results of treatment.

Spinal stenosis. Results of treatment. Seventy patients with spinal stenosis are reported according to the new international classifications. Cases where the stenosis was caused mainly by interluminar lesions such as disk protrusion are excluded. The treatment of patients with segmental disease and adequate technical decompression was generally successful while the patients with more generalized disease had less predictable end results. In spite of wide decompression of the lateral gutter of the spinal canal, there was little tendency to further olisthesis except in the degenerative spondylolisthesis group. Spinal fusion did not appear to be necessary except in this latter group of patients. Technetium polyphosphate scanning techniques have shown an active process in the facet joints of the spondylolisthesis group with degenerative disease.


Fibrous spinal stenosis. A report on 850 myelograms with a water-soluble contrast medium. Although osseous spinal stenosis was rarely seen, fibrous spinal stenosis was demonstrated in 6% of 850 lumbar myelograms done with 10 ml doses of water-soluble Dimer-X (Maybaker). The common antecedents of fibrosis were myelography with an oily medium and spinal operations. In mild affections only the nerve root sheaths were obliterated. More severe fibrosis produced additional stenosis of a segment of the thecal sac.


Degenerative spondylolisthesis.

Degenerative spondylolisthesis. Degenerative spondylolisthesis is one important type of spinal stenosis. The spinal canal stenosis varies in degree. This is the result of anterior slipping of the whole vertebra, usually L4 on L5. The clinical picture is not greatly different from that observed in the other types of lumbar canal stenosis. The surgical management involves decompression of the cauda equina by laminectomy. Often this is associated with arthrectomy to decompress the nerve roots. Extensive excision of the neural arch may result in further spinal instability for which spinal fusion is generally advisable.


Fracture after arthrodesis of the hip and knee. In 27 cases of fracture after arthrodesis of the hip and knee, there was a characteristic location and appearance which depended upon whether or not metal implant was present. Fracture healing and preservation of motion of adjacent joints was achieved in all cases with internal fixation using the plating techniques described by the A-O group. There is also always the opportunity to decorticate and add supplementary bone grafts for an arthrodesis that had failed before the time of fracture. Metal implants should be removed when there is evidence of consolidation and maturation of bone at both the arthrodesis and fracture sites.


Post-laminectomy and post-fusion stenosis of the lumbar spine. On the basis of a 9-year experience with 231 patients with post-laminectomy and post-spinal fusion stenosis of the lumbar spinal canal, we emphasize the importance of recognizing and adequately decompressing such lesions. In the majority of such patients pain relief has been achieved, but some of the failures can be attributed to technical reasons. Most failures are due to associated lesions and to functional factors. A special surgical techniy be advisable. The indications for fusion however were few and require further investigation and evaluation. The significant failure rate points to the need for continuing research into the causes of low back pain and adequate management programs for the patient with the "multiple operated back" who still has disabling pain and drug dependence.


Diffuse pigmented villonodular synovitis. An indication for total hip replacement in the young patient. Diffuse pigmented villonodular synovitis of the hip is a special problem because in this location it uniformly results in severe bony and cartilaginous destruction of the joint. In 2 cases treated by total hip replacement, both were successful at periods longer than 1 and 3 years follow-up with no evidence of recurrence of the disease, prosthetic failure, loosening, or any other complication despite the patients' young age and extremely active life styles. Continuous follow-up and frequent admonition about the wear erosion and recurrences of the synovitis is an essential part of the aftercare of these patients.


Abduction injuries of the distal femoral epiphysis. Based on a follow-up study of 15 distal femoral epiphyseal fractures, the following conclusions are drawn: Closed reduction with cross pinning of the distal femoral epiphysis provided slightly better results and prevented loss of reduction; angulation deformity, requiring corrective surgery occurred in four patients, two of whom had initial anatomical reductions; significant leg length inequality was not seen; abduction injuries of the distal femoral epiphysis are not uncommon in teenage football players.


Technique, errors and safeguards in modern Küntscher nailing. Intramedullary nailing after reaming of the medullary cavity according to Küntscher, provides a rigid fixation and makes early mobilization possible, and is even applicable to infected non-unions. Experience with 150 cases of fresh femoral fractures and more than 80 cases of non-union of the femur, the tibia, the humerus and the forearm, demonstrates that thorough familiarity with the instrumentation and the pitfalls of the technique, as well as the correct clinical indications of the method are critical to the achievement of good results.


Fat embolism following bilateral total knee replacement with the Guepar prosthesis. A case report. Fat embolism followed bilateral total knee replacement with Guepar prostheses in a rheumatoid patient the day after the operation. The risk of fat embolism following total knee replacement with a hinge prosthesis is especially high in rheumatoid patients with compromised pulmonary functions and a history of long-term treatment with corticosteroids.


Isolated partial tear of the anterior cruciate ligament. Isolated partial tear of the anterior cruciate ligament should be suspected in the patient with effusion, flexion contracture and poorly localized pain and tenderness following a knee injury. The diagnosis is difficult to make from physical findings or even arthrography. Arthroscopy is helpful in making the diagnosis and in ruling out associated meniscus lesions. A normal meniscus should not be removed if this seemingly trivial lesion is the only abnormal finding at arthrotomy. Surgical treatment is not necessary if the diagnosis can be made by other means. This injury responds well to immobilization in extension followed by rehabilitation.


Management of patellar subluxation. A modification of Hauser's technique. Patellar subluxation is one of the most common causes of internal derangement of the knee in young individuals. Most surgical techniques mandate entrance into the knee joint and require prolonged postoperative immobilization. The result may be excessive postoperative synovitis and occasionally, hemarthrosis. Prolonged postoperative immobilization results in joint stiffness. The authors propose a modification of Hauser's technique which allows tailored correction of the abnormal vector forces applied to the patella, simple adjustment of the tension in the extensor mechanism, creates patellar stability, and permits rapid return of knee motion. A new tibial corticocancellous window is created in a manner similar to Hauser's technique. The cancellous defect is deepened by curettage and the transferred tibial tubercle is then inverted, inserted through the window, and tamped into the graft bed thereby gradually increasing tension in the tendon. The cancellous and cortical bone from the window is then tamped in behind the patella tendon, buttressing the tendon, and permitting the knee a full unguarded range of motion on the operating table. In 23 operations in 22 patients, with a follow-up of 35.4 months and a mean patient age of 18.7 years, all patellae were stable. All but one patient achieved full range of  motion. Younger patients with minimal or absent preoperative patellofemoral chondromalacia had uniformly good results.


Giant synovial cyst of the calf and thigh in a patient with granulomatous synovitis. A giant synovial cyst with granulomatous synovitis was removed from the thigh and calf in an 80-year-old woman. The lesion included necrotizing, epitheloid cell granulomata with Langhans' type giant cells. Chest X-ray, tuberculin testing, cultures for Acid Fast bacilli, as well as aerobic, anaerobic and fungal cultures were all negative. The treatment consisted of synovectomy and total knee arthroplasty with an uneventful recovery. A giant calf cyst, usually associated with rheumatoid arthritis, but in this situation, noted in granulomatous synovitis seems not to have been reported previously.


Arteries and veins of the lumbar nerve roots and cauda equina. An abundant vascular system supplies the nerve roots, within the cauda equina, in the spinal canal and in the nerve root tunnels. The arterial supply of nervous tissue, as noted by previous observers, is "just adequate for its minimal needs." The veins of the area are classified into 3 groups, those of the spinal canal within the extradural space, those of the nerve roots themselves (radicular veins) and those which drain the bony skeleton. These thin-walled venous channels are a source of serious bleeding both at operation and in the postoperative period. Elsewhere in this symposium, emphasis has been placed on the way in which spinal stenosis and pressure on nerves cause the complex group of symptoms. Pressure on arteries, veins and capillaries can impair nerve conduction, with changes in sensation and loss of motor power in one or both limbs. If the pressure is prolonged, irreversible changes take place in the substance of the nerve roots. Recovery of sensation and of motor power following adequate surgical decompression will then be incomplete.


Functional treatment of intra-articular fractures of the calcaneus. Fifty-one adult patients with 54 intra-articular fractures of the calcaneus have been reviewed from one to 11 years after the injury. Treatment consisted in immediate active exercises of the foot without any attempt at reduction or immobilization. The patients resumed full weight-bearing, on the average, three months after injury. The overall results were excellent in 19, good in 24 and unsatisfactory, objectively and subjectively, in 11 feet. In this consecutive series, the majority of the fractures had a marked degree of displacement. Excluding undisplaced fractures which had a good result, no clear cut relation between the type and degree of displacement and the final result could be found. However, there were more unsatisfactory results in fractures in which the tuber-joint angle was equal to or less than 10 degrees.


Advancement of the tibial tuberosity.

Advancement of the tibial tuberosity. Surgical modifications of the biomechanics of osteoarthritic and chondromalacic patellofemoral joints reduce the joint pressure by distributing pressure evenly along the articular surfaces. Forward displacement of the patella tendon lengthens the lever arm of the tendon. It also increases the angle formed by the forces exerted by the quadriceps muscle and by the patella tendon. As a result, the compressive forces transmitted from the femur to the tibia and from the patella to the femur are decreased. If the anterior tuberosity of the tibia is displaced forward and medially, the subluxated patella is brought back into the intercondylar groove and the weight-bearing areas of the patello-femoral joint are increased. Consequently the operation much reduces the compressive stresses in the joint. In osteoarthritis of the patellofemoral joint and in chondromalacia of the patella, surgical displacement of the patella tendon forward consistently relieved pain.


Hormonal effects on the morphology of bone defect healing. Standard defects were produced in the radii of hypophysectomized immature rats. All animals were injected with Methimazole, and grouped according to hormone supplementation, growth hormone (GH), thyroxine (T4), the combination, or no hormones. Lack of GH and T4 caused a retardation of defect healing and callus formation but not a total cessation. The presence of GH in the hypophysectomized animal caused a larger callus due to greatly increased chondrogenesis throughout the 6 week study. Thyroxine in the hypophysectomized animal increased bone metabolism and caused more cartilage and bone formation than seen in the hormone deficient group, but not as great as that seen in the GH injected animals or the T4 and GH injected animals. Growth hormone allowed greater chondrogenesis; T4 enhanced maturation to bone. The combination allowed the development of a callus similar in stage and proportion of tissue to that observed in the pituitary intact animals. The influences of GH and T4 on the healing of a bone defect in the immature rat correspond to influences of GH and T4 on growing epiphyseal plate.


Alterations in pulmonary function, coagulation and fat metabolism in patients with fractures of the lower limbs. If the underlying pathology of the syndrome of fat embolism is the presence of circulating emboli of neutral fat with adherent platelets and red blood cells, then one could expect certain changes in normal vascular cellular elements and fat metabolism, with resultant alterations in pulmonary function. In our series of 118 patients with fractures of the lower limbs we found that more than half of them exhibited hypoxemia as well as a decrease in the hematocrit and platelet counts with a concomitant increase in platelet adhesiveness. In addition, those patients with hypoxemia showed increased fibrinogen degenerative product levels indicating an increased fibrinolysis. We found only a slight temporary rise in the serum triglycerides, but the nonesterified fatty acid levels rose sharply over the first three days following trauma associated with an increase in serum lipase. Our study demonstrated that this increase in serum lipase occurred slightly before the peaking tendency observed in the nonesterified fatty acids. Following trauma, fat emboli with adherent platelets and other vascular cellular elements are formed; we would expect that these emboli would lodge in the capillaries and small vessels of the lung, thereby producing a physiological shunt. An increase in the A-aDo2 confirmed this hypothesis and was associated with a decrease in the arterial oxygen level in over half the patients studied. Although 58 of our patients showed evidence of hypoxemia associated with a fall in hematocrit and platelet count, not one of them showed clinical signs and symptoms of the fat embolus syndrome. This study suggests that a subclinical form of fat embolism does exist. What causes a small percentage of those patients with subclinical fat embolism to progress to a clinical fat embolism is still unknown. The majority of our patients spontaneously returned to normal within 5 days. Reviewing the results of those patients who developed hypoxemia and the two patients who developed clinical fat embolism, there seems to be no indication of what causes the progression. Hypotension and shock do not seem to be relevant to the progression of the subclinical condition. Not one of 110 reviewed had evidence of shock or persistent hypotension, yet 58 of these patients developed changes in arterial saturation, vascular elements, and evidence of disseminated intravascular coagulation.


An ultrastructural evaluation of the effect of hydrocortisone on rabbit cartilage. Pharmacologic and supra-pharmacologic doses of hydrocortisone acetate did not effect ultrastructural alteration of chondrocytes in articular cartilage of mature rabbits. Early biomechanical alterations are unaccompanied by ultrastructural cytological changes. Not until advanced biochemical alteration is effected by large, repetitive doses, does the ultrastructural alteration begin.


Acute local tissue effects of polymerizing acrylic bone cement. An intravital microscopic study in the hamster's check pouch on the chemically induced microvascular changes. The chemical effect of polymerizing CMW and Simplex-P bone cements was recorded by intravital microscopy in the hamster's cheek pouch. Thermal effects and pressure on the tissue were eliminated. Where a direct cement-tissue contact was present, severe, apparently irreversible, microcirculatory disturbances were recorded. Both cements caused equally extensive microvascular damage. Intact epithelium and connective tissue appeared to protect the underlying vascular bed from the effect of the monomer. No differences in tissue reaction were recorded when the cement past was applied after normal and prolonged kneading.


Innervation of the lumbar spine.

Innervation of the lumbar spine. Back pain, in spinal stenosis, can arise from many sources. Apart from nerve root involvement any of the structures considered above can be implicated. In degenerative conditions, where discogenic and posterior facet pain are present, excess activity tends to increase these symptoms. In addition there is evidence that impulses reaching the spinal nerve root through the sinu-vertebral nerve and possibly the posterior ramus may potentiate the irritability of that root. Whether such a mechanism contributes to the claudication of degenerative spinal stenosis is not known.


Measurements of the lumbar spinal canal in 2 racial groups. Direct measurements of 1,340 lumbar vertebrae in 275 skeletons in two racial groups are reported. The average figure, and the upper and lower limits of normal are reported for the anteroposterior diameter of the canal and for Spinal Index. Radiological studies have established a technique for defining the posterior margin of the spinal canal on plain X-ray films. It is formed by a line joining the apex of the superior to the inverted apex of the inferior articular facet. The Spinal Index is not a reliable factor. The anteroposterior diameter alone is the essential parameter in assessing spinal stenosis. The negroid canal is marginally less spatial than that of the caucasoid.


Myelography in the lumbar disk syndrome. For myelography to convey the maximum information regarding theca size and relationships, and to avoid flow artifacts and other false positives, the theca must be filled to the L1-L2 level and X-rays taken with the patient upright thus ensuring a static column of dye.


Lumbar spinal stenosis. Radiographic diagnosis with special reference to transverse axial tomography. Spinal stenosis due to malalignment and/or hypertrophy of the bony margins of the spinal canal is a recognized cause of cauda equina compression and nerve root entrapment. The plain lumbosacral spine roentgenograms reveal the number of lumbar vertebrae, their alignment, their interpedicular distances, the height of the intervertebral disk spaces and the presence of osteophyte formation. It correlates poorly with encroachment on the spinal canal. The transverse axial tomogram directly demonstrates a cross-section of the spinal canal and will show abnormal areas of bone encroachment usually arising from hypertrophied lamina and articular processes. These narrow the posterior portion of the spinal canal and encroach on the lateral recesses. This examination does not demonstrate soft tissue hypertrophy and the stenosis may be even greater than what is apparent due to the bony encroachment. The myelogram expresses how the narrowed spinal canal affects the dural sac and its contained cauda equina. Not infrequently there is an associated herniated disk.


Pathological and myelographic changes in the major types of lumbar spinal stenosis. Correlated pathological and myelographic observations suggest that the combined types of lumbar spinal stenosis appear to be the most common. The posterior articular processes play the greatest part in producing narrowing--the inferior facet narrowing the central canal and the superior facet narrowing the nerve root canal.


Lumbar stenosis. An electromyographic evaluation. Analysis of bilateral EMG and operative findings reveal that there is a definite correlation between bilateral positive EMG in particular and multiradicular EMG's and the findings of stenosis or spondylosis of the lumbar canal. Electromyography is helpful in identifying the atypical patient or the patient with unilateral symptoms who actually has bilateral pathology. The importance of a bilateral electromyographic examination is emphasized and the rarity of bilateral or multiradicular findings in simple herniated nucleus pulposus.


The treatment of spinal stenosis.

The treatment of spinal stenosis. Decompression usually relieves leg pain and enables the patient to walk normal distances. Some back pain may remain. This is often helped by a light elastic support. If there was loss of sensation and motor power before operation, return may be considerable. The operation is only a small part of the total treatment of spinal stenosis. By relieving the pressure on nerves and blood vessels, it paves the way for the postoperative measures previously outlined. These are aimed at rebuilding atrophied muscles and restoring movement to stiff joints. We emphasize the importance of dealing not only with central stenosis involving the central canal, but also of making certain that there is no compression of the spinal nerves in their canals as they pass out through the foramina.


The subspecialist and the child.

The subspecialist and the child. Specialty services for children may be defective because the subspecialist has not had adequate training in general pediatrics. Pediatric and pediatric surgery postgraduate programs should encourage this type of training for all subspecialists who care for children. Unless or until this occurs, the pediatrician must remain involved in the care of his patients whether their problems are primarily medical or surgical.


Results of decompression for lumbar spinal stenosis. Approximately 80% of patients with spinal stenosis return to their usual occupations following decompressive laminectomy. It is essential to recognize distinctive features of stenosis on myelography and in accordance with the individual patients' clinical problems, to carry out an adequate decompression.


The outcome of staphylococcal bacteremia in childhood. "The prognosis is better than previously reported". Fifty infants and children were treated for staphylococcal infections complicated by bacteremia. Of these, 28 had serious underlying diseases, principally leukemia (15 cases). All were treated with intravenous antibiotics for a median duration of 12.7 days. Although 13 patients died (26%), the staphylococcal infection had apparently been eradicated in all but three (6%), one of whom died before treatment could be started. The relatively brief treatment periods required in even severely compromised leukemic patients and the survival of all but one of 22 previously healthy patients with staphylococcal bacteremia suggest that the prognosis is better than previously reported.


The medical and surgical management of patients with congenital heart disease. A survey of current knowledge and practices. Today, techniques for diagnosis,medical preparation, and definitive surgical repair are available for most cardiac anomalies, if needed. These permit successful treatment and carry a low mortality. Such children can now be expected to lead normal and meaningful lives as contributors to society. When serious symptoms occur in infancy, as discussed herein, an emergency exists and prompt diagnosis and treatment are mandatory for survival.


Influenzavirus A2 infections presenting with febril convulsions and gastrointestinal symptoms in young children. We present the clinical features of Influenzavirus A2 infection in 75 young children admitted to a children's hospital. The most common presenting features were febrile convulsions. vomiting, coughing, diarrhea, and anorexia. At any age, the illness may present with respiratory tract symptoms and signs but in young babies gastroinestinal symptoms are often the presenting complaint. Children aged one to three years often present with febrile convulsions. Only in older children does the adult pattern begin to emerge. Evidence is put forward to suggest that encephalitis in association with influenza can be due to direct invasion of the central nervous system by the virus.


Plasma renin activity as a function of age in two new strains of spontaneously hypertensive and normotensive rats. 1. Strains of spontaneously hypertensive and normotensive rats were selected by repeated inbreeding. 2. Brief ether anesthesia was shown to produce a two- to three-fold increase in plasma renin activity in both strains. 3. Plasma renin activity was significantly higher in young spontaneously hypertensive than in normotensive rats of the same age (5-7 weeks). After the ninth week plasma renin activity decreased and, at week 45, became significantly lower in hypertensive than in normotensive rats. 4. When hypertension was established a significant inverse relationship was found between plasma renin activity and systolic blood pressure in spontaneously hypertensive and in normotensive rats. 5. It seems unlikely that the renin-angiotensin system plays a major role in the maintenance of the established spontaneous hypertension in this strain. However, renin hypersecretion may be important in the early pre-hypertensive stage of genetic hypertension in rats.


The functional response of the dog ileum to one hour's ischaemia. 1. The function and structure of dog ileal mucosa was examined immediately after arterial ischaemia for 1 h and 1, 3 or 7 days after the trauma. 2. Immediately after the ischaemia, there was a net movement of water and ions into a luminal perfusate in vivo. One day later, there was no net movement of water and electrolytes but net absorption returned on the third day. 3. Active transport of phenylalanine or beta-methylglucoside by mucosal strips in vitro was abolished immediately after the trauma but was largely restored 1 day later. There was a close correlation between glucose absorption in vivo and beta-methylglucoside uptake in vitro. 4. Morphological study revealed pronounced desquamation of enterocytes immediately after the trauma. The regenerating mucosa had shorter villi and crypts, and lower enzyme activities assessed histochemically 1 day later. Most parameters had returned to normal by the third post-operative day.


Measurement of an index of muscle capillary permeability and its correlation with serum insulin values in maturity-onset diabetic subjects. 1. An index of capillary permeability was obtained by measuring the ratio of the clearance rate of 77Br to that of 133Xe in the anterior tibial muscle, after a short period of maximal ischaemic exercise. 2. Seventeen control subjects and thirty-two maturity-onset, non-insulin-treated diabetic subjects, aged 60 years or less, were studied. Short glucose tolerance tests were performed in the diabetic subjects during which blood sugar and serum insulin concentrations were estimated. 3. The 77Br/133Xe clearance ratio was increased in the diabetic subjects compared with the control subjects. In the diabetic subjects, there was an inverse correlation between the insulin at 60 min after glucose and the 77Br/133Xe clearance ratio. There was also a direct correlation between the 77Br/133Xe clearance ratio and the age of the patient in the diabetic group but not in the control group. 4. The results demonstrate that a reduced insulin response to oral glucose is associated with increased capillary permability and may play a role in the development of microangiopathy.


Evidence for both luminal and systemic factors in the control of rat intestinal epithelial replacement. 1. Isolation of a self-emptying sac of rat small intestine in vivo halved the cell production rate in the crypts of Lieberkühn as measured by colchicine blockade. 2. Starvation for 48 h of rats with isolated intestinal sacs caused a further halving of cell production rate in the sac. 3. Infusion of distilled water into isolated intestinal sacs for 72 h caused a similar degree of stimulation of cell production in sacs in fed and starved rats, suggesting that the fall in cell production rate on starving a rat bearing an isolated sac is not due to t-e non-availability of the substances required for cell synthesis. 4. The possible contribution of innervation of the gut, and of systemic hormonal influences, on intestinal epithelial replacement is discussed.


The effect of chelating agents on cellular iron metabolism. 1. The effect of iron chelators on iron uptake, ferritin and total protein synthesis was studied in cultured Chang cells. Desferrioxamine depressed ferritin synthesis and completely inhibited iron uptake by ferritin protein. Rhodotorulic acid reduced iron uptake by the cells but had little effect on ferritin synthesis. Diethylenetriamine pentaacetic acid produced complete inhibition of iron uptake and all protein synthesis. 2,3-Dihydroxybenzoic acid (2,3-DHB) had no effect in this system. 2. When 2,3-DHB was incubated with a liver homogenate, its subsequent addition to a Chang cell culture resulted in depression of ferritin synthesis, iron uptake into the protein and some depression of total protein synthesis. Pretreatment of rhodotorulic acid did not affect its properties. 3. Non-ferritin iron in the Chang cell cytosol was dialysable, available for binding to transferrin and formed chelates which appeared, on gel chromatography, to be of low molecular weight. Gel chromatography of cytosol after incubation of the cells with chelating agents showed non-ferritin iron to be in a similar form. 4. Loss of non-ferritin iron from the cells occurred only when the transferrin in the medium was unsaturated. In the presence of chelating agents non-ferritin iron was lost from the cells even when transferrin was 100% saturated. 5. The results confirm the presence of an intracellular labile iron pool which is available for chelation, and demonstration that different iron chelators have different metabolic effects.


Cell size and glucose oxidation rate in adipose tissue from non-diabetic and diabetic obese human subjects. 1. The rate of oxidation of [1-14C]glucose to 14CO2 was examined in subcutaneous adipose tissue from fifteen obese non-diabetic subjects and from eleven obese maturity-onset diabetic patients. Production of 14CO2, measured in the basal state and in the presence of insulin, was significantly correlated with mean cell size in both the non-diabetic and the diabetic subjects, independent of age, relative weight and fasting plasma insulin concentration. 2. Comparison of the regressions of glucose oxidation rates on mean cell size indicated: (i) that insulin produced a significant increase in activity over the basal value in both groups, and (ii) that basal and insulin-stimulated activity were both significantly lower in diabetic than in non-diabetic adipose tissue.


Urinary excretion of hydroxylysyl glycosides during acute inflammation in the rat. 1. Subcutaneous inflammatory granuloma were induced in young rats and the urinary excretion of hydroxyproline and hydroxylysyl glycosides was observed during the period of acute inflammation. 2. All collagen metabolites were increased in the urine and excretion of glucosyl-galactosyl-hydroxylysine was much greater than excretion of galactosyl-hydroxylysine in the first days. 3. It is argued that urinary glucosyl-galactosyl-hydroxylysine is probably derived from hydroxylysyl residues of soluble collagen. 4. This study affords new arguments in favour of the dermal origin of urinary glucosyl-galactosyl-hydroxylysine, at least in skin inflammation.


Assessment of responsiveness to carbon dioxide in patients with chronic airways obstruction by rate of isometric inspiratory pressure development. 1. Responsiveness to CO2 was measured in forty patients with chronic airways obstruction in terms of ventilation and rate of isometric inspiratory pressure change [(dP/dt)max]. 2. The ventilatory response was below the normal range in eighteen out of twenty-two patients with normal arterial CO2 tensions and in all of eighteen patients with CO2 retention. 2. The (dP/dt)max. response was distributed throughout the normal range in all but one of the patients with normal arterial CO2 tension. In all the patients with CO2 retention the (dP/dt)max. response was either at or below the lower limit of the normal range. 4. Although the ventilatory responses correlated significantly with FEV1 there was no such correlation for the (dP/dt)max. responses. 5. The (dP/dt)max. response showed a significant negative correlation with Pa,CO2. 6. It is believed that the (dP/dt)max. response to CO2 can be used to assess central CO2 responsiveness in subjects with airways obstruction independently of mechanical factors limiting their ventilation.


Effect of nutritional status on rat adipose tissue, muscle and post-heparin plasma clearing factor lipase activities: their relationship to triglyceride fatty acid uptake by fat-cells and to plasma insulin concentrations. 1. In rats in a variety of nutritional states, the adipose tissue clearing factor lipase activity is strongly, positively correlated with fat-cell triglyceride fatty acid uptake. 2. In the same animals, muscle clearing factor lipase activity is inversely correlated with the activity of the enzyme in adipose tissue and with the plasma insulin concentration. 3. In starved animals that are given glucose, adipose tissue clearing factor lipase activity is positively correlated with the plasma insulin concentration. 4. The effect of changes in nutritional status on the activity of clearing factor lipase in rat post-heparin plasma depends on the heparin dosage used. The administration of glucose, but not of fructose or sucrose, to starved rats alters the response to heparin injection towards that found in rats in the fed state.


The relation between the excretion of sodium and water and the perfusion pressure in the isolated, blood-perfused, rabbit kidney, with special reference to changes occurring in clip-hypertension. 1. The sodium and water excretion rates of rabbit kidneys were studied when isolated and perfused at known pressure with blood from another normal anaesthetized rabbit. Studies at several different perfusion pressures confirmed that a small rise in perfusion pressure caused a large rise in sodium excretion and that the potential sodium-excreting ability of the isolated kidney was high. The curve obtained could be closely fitted by a quadratic equation which allowed an estimate to be made of the blood pressure below which no urine is formed, i.e. the 'theoretical perfusion pressure threshold'. For normal kidneys this was 55-4 mmHg. 2. A group of rabbits had a silver clip applied to the left renal artery and, 3-6 weeks later, the eight most hypertensive animals were selected to provide their kidneys for perfusion. Both kidneys were perfused simultaneously. The clip on the left renal artery was removed immediately before perfusion and the cannula placed distal to the stenosis in the post-stenotic dilatation. The function curves of these kidneys were compared with the curves obtained from normal kidneys. 3. The untouched kidney contralateral to the clip was found to require a significantly higher perfusion pressure (71-7 mmHg) for it to achieve a given sodium excretion rate and, surprisingly, the clipped kidney showed a similar functional change (76-4 mmHg). In other words the positions of both function curves were shifted though their slopes were not much changed. 4. Both kidneys in single-clip-hypertension appear to adapt or reset their sodium excretory behaviour. The resetting in the untouched kidney allows hypertension to be sustained without undue sodium loss. Aldosterone probably contributes little to the resetting. We infer, indirectly, that the normal kidney may, to a significant extent, restrain sodium excretion by virtue of its sympathetic innervation. We also opine that the kidney cannot be assigned fixed intrinsic functional properties on which a renal sodium-handling theory of long-term blood pressure regulation can be firmly based.


A simple method of measuring breath hydrogen in carbohydrate malabsorption by end-expiratory sampling. 1. A simple method is described for measuring the hydrogen concentration in alveolar air by end-expiratory sampling, by using a modified Haldane-Priestley tube and gas chromatography. Hydrogen was generated in vivo by ingestion of the non-absorbable sugar lactulose. 2. Alveolar hydrogen concentration showed a highly significant correlation with hydrogen production measured either by a rebreathing technique or by a total collection procedure. 3. The coefficient of variation of the end-expiratory method, assessed by comparing sixty-one paired results, was 11-6%. The coefficient of variation in ten measurements in one subject at 1 min intervals was 17-6%.


The changing ecology of bacterial infections in children. There is continued change in the organisms involved in commonly encountered infections. Although the major organisms have changed less in pediatric than in medical or surgical infections, the advances in neonatology and the chemotherapy of leukemia have resulted in cases in which infection with  once uncommon organisms is now commonplace. Perhaps more disheartening has been the increasing resistance of bacteria to antibiotics. Since resistance patterns are so much a reflection of antibiotic usage patterns in an institution, each pediatrician must be aware of the species of bacteria and the resistance patterns of the bacteria isolated in his hospital, particularly in neonatal, intensive care, and burn areas where there is the highest use of antibiotics. Close interaction of pediatrician, diagnostic microbiology laboratory, and hospital epidemiologist can provide early clues to possible bacteria involved in infection, as well as suspected antibiotic resistance patterns.


Peptic ulcer disease in children.

Peptic ulcer disease in children. Physician recognition of peptic ulcers in children is a challenging problem because of the multiple, often nonspecific, symptoms. A compatible history and upper gastrointestinal contrast study were formerly all that was available to the practitioner trying to confirm his clinical impressions. With the advent of new developments in gastroduodenal endoscopy, lesions not detectable radiologically can be localized, and the diagnosis firmly established. As experience with this procedure in children accumulates, the incidence of other conditions previously attributed to ulcer disease may be apparent, thus enlarging our concepts of causes of upper gastrointestinal bleeding in children.


Immunology of Allergy.

Immunology of Allergy. Immune reactions, presumably developed to rid organisms of troublesome invaders, are rather frequently associated with responses that result in injury to host tissue. Such responses are manifestations of allergy or hypersensitivity, and involve antibodies of certain immunoglobulin classes, complement components, mast cells and basophils, lymphocytes, macrophages, and various pharmacologic mediators and other soluble substances in an exuberant array of possible combinations. An understanding of clinical hypersensitivity diseases is aided by classifying basic allergic mechanisms into four main types: anaphylactic (Type I), cytotoxic (Type II), complex-mediated (Type III), and cell-mediated (Type IV), which may participate in various combinations in disease states.


Serologic evidence of equine leptospirosis in the northeast United States. Serologic testing for leptospiral antibody was conducted with the macroscopic agglutination test on 1,346 equine serum samples. These were collected from clinically normal horses in 123 purebred herds in the Northeast. Sixty-eight samples (5%) from the population tested reacted at significant levels (1:40 or higher) to one or more of the 5 serotype antigens used. These reactors were from 38 (31%) of the herds tested. Reactions to serotype pomona predominated in 25 (72%) of these 38 herds. Smaller numbers of herds had reactors to canicola, icterohemorrhagiae and grippotyphosa. No significant reactions to serotype hardjo were detected.


A rheumatoid-like arthritis in calves.

A rheumatoid-like arthritis in calves. Arthritis characterized by lameness. Joint swelling and purulent synovial fluid was seen in a group of dairy replacement heifers. Mycoplasma was cultured from one joint aspirate, but all bacterial cultures were negative. Antiglobulins were demonstrated by double diffusion precipitin tests in the serum and synovial fluid. Due to the clinical and clinical pathological similarities to rheumatoid arthritis in man, the disease was called rheumatoid-like arthritis. The presence of antiglobulin may indicate antibody in the synovial fluid explaining the difficulty in culturing a causative agent.


The pathology of subacute methylmerculialism in swine. Clinical signs of toxicosis, neurologic lesions, and elevated tissue residues of methylmercury (MM) were produced in 12 pigs by oral administration of 1.29, 0.86, 0.64, and 0.43 mg mercury/kg of body weight daily as methylmercuric hydroxide (MMH). Clinical signs which began on day 17 were ataxia, dysmetria, blindness, convulsions, paresis, and death. Time of onset of signs was inversely related to size of daily dose. Microscopic lesions were found in the cerebrum brain stem, and spinal cord, and correlated well with clinical signs. The cerebrum in which severity of lesions was directly related to length of exposure was the most severely affected region of the central nervous system (CNS). Lesions were neuronal necrosis, neuronophagia, cortical vacuolation, axon swelling, gliosis, leptomeningitis, and vascular fibrinoid necrosis. Neuronal necrosis was most extensive within mid and deep cerebrocortical laminae. Brain residues of MM were directly proportional to the size of daily dose, and statistically significant. Distribution of MM among different tissues was rather uniform with highest concentrations found in liver, followed by kidney, muscle, spleen, and brain.


Naturally occurring cerebrospinal parelaphostronglylosis. An isolated case and an outbreak of parelaphostrongylosis in goats are described. Signs included tetraparesis, hemiparesis, tetraplegia, spastic gait, scoliosis, vestibular strabismus, blindness, and death. Five cases were necropsied and nematodes were seen in the brain and spinal cord of four of these. Intact adult nematodes from two cases were identified as Parelaphostrongylus tenuis, the meningeal worm of white-tailed deer. Cerebrospinal fluid analysis from affected goats showed a moderately elevated protein content, evidence of hemorrhage, and mononuclear cell and eosinophil pleocytosis. Recoveries are recorded.


A malignant neoplasm resembling a circumanal gland adenocarcinoma in a dog. In the neoplasm of this report a final diagnosis of a circumanal gland adenocarcinoma invading the vertebral column and canal was made based on the histologic appearance. No growths were noted in the circumanal gland region and the location of the primary neoplasm is open to debate.


Adjustment of cephaloridine (Keflodin): dosage according to its pharmacokinetics. The determination of the serum and urine concentrations of cephaloridine permitted calculation of the pharmacokinetic constants of this antibiotic: after administration of a 1-gram intravenous dose in five normal subjects; after administration of a 1-gram intramuscular dose in five normal subjects, five patients with renal impairment and five patients on maintenance hemodialysis. In normal subjects, serum half-life averaged 1.56 h (Ke=0.4445) after intravenous administration and 1.63 h (Ke=0.4254) after intramuscular administration of a 1-gram dose of the antibiotic. The urinary excretion of cephaloridine over the 6 h following its intramuscular administration in normal subjects amounted to 56.4% of the administered dose. The renal clearance of cephaloridine was 194 ml/min. A linear correlation (Ke=0.0670+0.0028 CrCl) was established between overall elimination rate-constant values and the creatinine clearances of the patients under investigation. These data were used to calculate the maintenance and loading doses and intervals adjusted to creatinine clearance values. Accurate dosage regimens adjusted to the renal status of each individual patient were derived from the calculated values.


Comparative pharmacokinetic studies of ornidazole and metronidazole in man. Pharmacokinetic characteristics of ornidazole and metronidazole were compared in man. Both drugs were labelled with 14C in the imidazole ring at position 2. Four healthy volunteers were given an oral dose of 750 mg of one of the drugs, followed 2--4 weeks later by the same dose of the other. The same technique for determining the unchanged compound was used for both drugs. Results may be summarized as follows: mean peak concentrations in the plasma of 10.9 mug/ml for ornidazole and of 12.3 mug/ml for metronidazole were reached 2--4 h and 30--60 min after administration, respectively; both drugs showed the same volume of distribution. Their binding to human plasma proteins was less than 15%; the mean half-life of elimination from the plasma was 14.4 h for ornidazole and 8.4 h for metronidazole; the mean radioactivity recovered from the urine and faeces during the first 5 days was 85% of the dose for ornidazole and 91% for metronidazole, the major proportion in each case being excreted in the urine; the radioactivity found in the faeces was 22.1% of the dose for ornidazole and 13.9% for metronidazole.


Characteristics of biliary excretion of cefazolin and other cephalosporins with reference to the relationship between serum levels and administration conditions. The biliary excretion of cefazolin was compared with that of cephalothin and cephaloridine in rats and man. In rats, the biliary levels were dose-related with cefazolin and cephalothin but not with cephaloridine. Biliary levels were higher than serum levels after injection of 10--80 mg/kg of cefazolin and cephalothin, whereas serum levels of cephaloridine after injection were higher than biliary levels. The highest biliary levels of cefazolin were obtained by intravenous injection, followed by intramuscular injection and drip infusion. In man, a crossover study was made to compare biliary levels of cefazolin with those of cephaloridine and cephalothin. After a single 1-gram intravenous injection, the peak levels of cefazolin ranged from 0.85 to 21 mug/ml and those of cephaloridine varied from 0.55 to 3.9 mug/ml. After a 3-gram intravenous injection, the peak biliary levels of cefazolin ranged from 35.5 to 270 mug/ml and those of cephalothin from 0.3 to 64 mug/ml. The chemotherapeutic biliary levels of cefazolin able to inhibit susceptible organisms were obtained by 3-gram intravenous injections.


Sulphamethoxazole-trimethoprim: effect on antibody response in man. The possible immunosuppressive properties of the combination sulphamethoxazole-trimethoprim or either of the agents alone were studied in healthy human volunteers. The effect of the 4-day drug treatment on the antibody synthesis after vaccination was measured by titrating tetanus antitoxin,  mumps antibody and Salmonella Hb antibody levels 4 and 5 weeks after vaccination. No significant differences were found in mumps or Salmonella antibody titres in the drug-treated group compared to controls. Tetanus antitoxin levels, however, were significantly lower than in controls after the combined drug. When a fourfold or greater increase in tetanus antitoxin titre was obtained in 75% of controls, the respective figures were 38% in the sulphamethoxazole-trimethoprim-treated group (p less than 0.05), 45% in the trimethoprim group (p greater than 0.05), and 50% in the sulphamethoxazole group (p greater than 0.05). The implications of these findings are discussed.


The effect of erythromycin on the growth of Rickettsia prowazekii in the body louse (Pediculus humanus corporis L) and the tick (Ornithodoros moubata Murray). Body lice (Pediculus humanus corporis L) and ticks (Ornithodoros moubata) that had been infected with Rickettsia prowazekii received varying doses of erythromycin. The anti-rickettsial activity of this drug was evaluated with regard to the determination of the numbers of surviving microorganism (LID100) and the in vivo concentration of erythromycin in both arthropod hosts. Erythromycin was found to exert a rickettsiostatic effect in lice, whereas in ticks the drug at concentrations of 0.3--0.04 mug/mg body weight completely eliminated R. prowazekii.


Fosfomycin in Osteomyelitis.

Fosfomycin in Osteomyelitis. Fosfomycin was exclusively used as antibiotic treatment in 37 patients suffering from osteomyelitis, out ot which 23 were operated for sequestrectomy or fistulectomy, whereas the remaining 14 did not undergo any surgery during fosfomycin treatment. Fosfomycin was adminsitered parenterally, alone or combined with oral administration, and in some cases only orally. The dosage varied from 4 to 8 g/day for an average period of 3 weeks. After one or two treatments the results were 29 definitive cures (78%), 2 failures and 6 relapses (22%).


Comparative assessment of cylacillin and ampicillin by experimental therapy and by serum level determinations in rats and mice. Therapy of chronic E. coli pyelonephritis in rats was equally effective with cyclacillin and oral ampicillin, whereas intramuscular ampicillin had a significantly higher therapeutic activity than oral cyclacillin. Serum concentrations in rats and mice were consistently higher with cyclacillin than with ampicillin and showed great variations depending on the animal species. It was concluded that there is a good correlation between in vivo and in vitro activity of both antibiotics, provided that the serum levels are taken into consideration. On this basis it may be predicted that a man cyclacillin will exhibit lower therapeutic activity in gram-negative infections than ampicillin.


The simultaneous quantitative determination of total, 'active', acetylated and conjugated sulfonamide in biological fluids. Methods are proposed which, in combination with those described in an earlier publication by the author, enable the separate determination of the two main types of sulfonamide metabolites, the N4-acetyl derivative and the conjugates, besides the total and the active sulfonamide in body fluids.


Conversion of benzylpenicillin to penicilloic acid in patients with chronic bronchial infections. A colorimetric method was modified to estimate the levels of benzylpenicillin and its penicilloic acid in urine. When benzylpenicillin was given orally to healthy volunteers, both it and its penicilloic acid were detected in the urine. When benzylpenicillin was given by intramuscular injections to these volunteers, only benzylpenicillin was detected in the urine. Patients suffering from chronic bronchial infections that exhibited beta-lactamase producing gram-negative bacteria in their sputum were given benzylpenicillin intramuscularly. It was found that both benzylpenicillin and penicilloic acid were recovered from the urine of such patients.


Effect of trimethoprim on the occurrence of drug-resistant coliform bacteria in the faecal flora. The occurrence of drug-resistant coliform bacteria was studied in the faecal flora of 30 persons receiving for 3 weeks either trimethoprim alone, a combination of sulphamethoxazole and trimethoprim, or a combination of sulphamethoxydiazine and sulphamethoxazole. Bacterial sensitivity was tested against trimethoprim, sulphamethoxazole-trimethoprim, sulphamethoxazole, and sulphaisodimidine. After treatment with trimethoprim alone, no increase in the occurrence of strains resistant to either trimethoprim or sulphonamides was observed. After treatment with sulphamethoxazole-trimethoprim, the faecal flora contained an increased percentage of sulphonamide-resistant coliforms but significantly less than found after treatment with sulphamethoxydiazine-sulphamethoxazole. In the persons receiving the sulphonamides only, a rapid increase in sulphonamide-resistant coliforms was observed. During the whole study, only one trimethoprim-resistant coliform strain was detected.


Myths and mechanisms of meiosis.

Myths and mechanisms of meiosis. A comparative analysis of the meiotic secquence in a wide variety of organisms indicates there is no convincing evidence that: (1) Premeiotic pairing plays any role in the synapsis of homologues. (2) Heterochromatic association facilitates homologous pairing. (3) Chiasmata ever form within segments which are positively heteropycnotic at zygotenepachytene. (4) Localisation of chiasmata depends on prior localisation of pairing or on the occurrence of euchromatin-heterochromatin boundaries. (5) Prior association of centromeres plays any role in determing co-orientation. (6) Any form of supra-chromosomal organisation exists involving permanent association between the members of a haploid complement, and (7) Unequal progeny ratios recovered from structurally modified Drosophila complements arise as a consequence of distributive pairing.--On the other hand there is good evidence that: (1) Interlocking of bivalents can occur regularly in species with a chiasma frequency sufficiently high to regularly produce ring bivalents and in which the chiasmata are localised to the ends of the bivalent. (2) Some forms of terminal association cannot represent terminalised chiasmata. (3) U-type exchanges present at diplotene result from errors in crossing over. (4) Pairing and chiasma formation are not necessary for coorientation, and (5) at least some types of elastic constrictions present at first metaphase represent extended nucleolar organisers.


The in situ formation of DNA-DNA duplexes of drosophila virilis satellite DNA. The DNA of Drosophila virilis brains and imaginal discs was labeled in vitro to a specific activity of 6 X 10(-5) dpm/mug, using an organ culture medium. The DNA was fractionated on neutral and alkaline CsC1 gradients and the heavy strands of satellite I annealed in situ to denatured polytene chromosomes from squash preparations of larval salivary glands. Nuclease S1 from Aspergillus oryzae was used to digest the unpaired ssDNA, resulting in a distinct labeling of the alpha-heterochromatin in the chromocenter and a small amount of diffused labeling in the proximal beta-heterochromatic part of the X-Chromsome.


Light and electron microscopy of rat kangaroo cells in mitosis. III. Patterns of chromosome behavior during prometaphase. Chromosome orientation and behavior during prometaphase of mitosis in PtK1 rat kangaroo cells were investigated by cinémicrography and electron microscopy. The first chromosome movements occur soon after the nuclear envelope begins to break down in the region near each pole. Initial chromosome behavior is primarily determined by the distance from the kinetochore region to the spindle poles. The predominant pattern is a movement to and/or association with the proximal pole. Movement to and association with the more distant pole, or direct alignment at or near the spindle equator (direct congression) are less frequent patterns. Except for rare cases, pole-associated chromosomes congress sooner or later and most congressed chromosomes oscillate about the equator.--Ultrastructural observations suggest that pole-associated chromosomes are oriented only to the poximal pole (monotelic or syntelic orientation) and they demonstrate that the sister-kinetochores of congressing or oscillating chromosomes are oriented to opposite poles (amphitelic orientation).--Based on the structure of the early prometaphase spindle and four assumptions concerning the formation of kinetochore fibers and their force-producing interaction with complementary elements, the different patterns of chromosome behavior observed can be explained as a result of synchronous or asynchronous formation of sister-kinetochore fibers. The few chromosomes whose kinetochore region is approximately equidistant from the poles amphi-orient immediately because their sister-kinetochores form fibers synchronously and they congress directly because of the bidirectional forces to which they are subjected. The kinetochore region of most chromosomes is not equidistant from the poles. Therefore, they form a functional fiber first to the nearer pole and move to, or associate with it, it because of the unidirectional force. Eventually, however, these chromosomes achieve amphitelic orientation and congress. Once established, amphitelic orientation is stable. Re-orientations do not occur during congression or oscillatory movements.


Centriole behavior in early mitosis of rat kangaroo cells (PTK2). Behavior of the centriolar duplexes during early mitosis was investigated. In general, both duplexes are capable of migrating about the cell as a unit with little change in their center to center spacing prior to separation to form the spindle poles. This duplex separation may occur at any point within the mid-prophase-prometaphase period. If it is delayed to prometaphase, transitory monopolar spindles were observed.


Effects of treatment on differential staining of BrdU labeled metaphase chromosomes: three-way differentiation of M3 chromosomes. In this paper methodology is described which yields three-way Giemsa differentiation (light-medium-dark) in human metaphase chromosomes exposed to 5-bromodeoxyuridine (BrdU) for 3 DNA synthetic periods (or exposed for 2 DNA synthetic periods and removed from exposure for the third) by means of which all of the sister chromatid exchanges (SCEs) occurring during (or shortly after) S1, S2 and S3 can be accurately counted and distinguished from one another. Using these methods it has been demonstrated that approximately twice as many SCEs occur during the first S-period in the presence of the drug (labeling=B1T0XT0B1)1 as occur during the second S-period (labeling=B2B1XT0B2)1. The three-way differentiation pattern is thought to result from a stepwise decrease in the amount of BrdU incorporated during the first, second and third DNA synthetic periods. These methods can also be used to differentiate between unlabeled (T2T0) and unifilarly labeled (B1T2) sister chromatids and are potentially useful in the detection of sub-chromatid exchanges (none were detected).


Karotype, DNA replication and origin of sex chromosomes in Anopheles atroparvus. Anopheles atroparvus has two pairs of autosomes similar in length and morphology and two sex chromosomes with equal, heterochromatic, late replicating long arms with homologous C-, G-, and Q-bands. The short arm of the Y is shorter than that of the X and both are euchromatic. The mean number of chiasmata per cell in the male is 3.2. During mitosis there is a high grade of somatic pairing but X and Y, which form a heteropycnotic mass in the interphase nucleus, have a differential behaviour. The chronology of DNA replication was studied in spermatogonia and brain cells by autoradiography. It is hypothesized that the present sex chromosomes of A. atroparvus evolved by accumulation of sex determining factors and gene deterioration resulting in heterochromatinization of the long arms, followed by structural rearrangements.--The homology of the two sex chromosomes requires limited dosage compensation which is achieved either as in Drosophila by modifier genes or by accumulation on the short arm of the X, only of female determining factors which do not require dosage compensation.


The location of ribosomal cistrons (rDNA) in chromosomes of the rat. In situ hybridization of 3H-labelled ribosomal RNA to the chromosomes of rat bone marrow cells revealed that clusters of ribosomal cistrons (rDNA) are located in the secondary constrictions of chromosomes No. 3 and 12 and near the centromere of chromosome No. 11, both associated with the late DNA-replicating regions. They were not found in Nos. 1, 2, 13, 19, 20, and the Y chromosome.


Random distribution of centromere regions at mitosis in cultured cells of Muntiacus muntjak. The manner in which centromere regions of mitotic chromosomes are distributed with respect to the age of their DNA was studied. Cells of the Indian deer Muntiacus muntjak, were grown in the presence of bromodeoxyuridine (BrdU) for two generations and stained with the fluorescent dye Hoechst 33258. Chromatids containing "granddaughter DNA" appear dim when compared with those containing "grandparental DNA". The frequencies of the various anaphase patterns of bright and dim centromere regions were binomially distributed, indicating random distribution of chromatids with respect to the age of their DNA templates.


Sequence of centromere separation of mitotic chromosomes in Chinese hamster. Chromosome preparation in late metaphase cells from bone marrow of colcemid treated male Chinese hamsters were used to analyse the sequence of separation of sister centromeres. Chromatids of chromosomes 2 and 1 are the first ones to separate at centromeres, followed by members of group B, D and C. Some acrocentric chromosome is always the last one to separate at the centromere. The data point to a possible correlation between the position of a centromere in the separation sequence in the genome and the amount of centromeric heterochromatin as well as relation to the phenomenon of non-disjunction.


Electron microscopic studies on the polytene chromosomes of Chironomus thummi salivary glands. I. Ultrastructural mapping. The method of ultrathin sections of unsquashed salivary gland polytene chromosomes of Ch. thummi was applied to their ultrastrual mapping. There was a good agreement between electron micrographs and Hägele's light microscopic map (1970) with respect to the pattern and number of bands. 94% of bands were identified in larval and prepupal chromosomes. In Ch. thummi, band thickness varied from 0.05-0.5 mum. Most characteristic were 0.2-0.3 mum bands. Morphologically, bands were classified as: continuous (frequently with holes and gaps), discrete, dotted and continuous-discrete, discrete-dotted. Band morphology is related to band size, such that smaller bands, as a rule, were also dotted. Bands beginning to puff likewise became dotted. Interbands in unsquashed chromosome sections were from 0.05-0.15 mum. The smallest interbands contained only fibrils, in the larger interbands few granules could be observed. This makes interbands distinguishable from a typical puff with many such granules.


Gas gangrene infections of the small intestine, colon and rectum. Thirty-three cases of gas gangrene infections originating from the small bowel, colon, and rectum are reviewed. The distinction between localized and diffuse, spreading, types of infection is made. The overall mortality rate was 42.4% and mortality was highest for infections following elective bowel resections. Treatment consisted of antibiotics and surgical debridement, with hyperbaric oxygen used as adjunctive therapy for the more serious cases. The importance of early recognition of clostridial infection is stressed as the key to improved survival.


Intraoperative fiberoptic colonoscopy--"the difficult polypectomy". An alternative to transcolonic polypectomy, transabdominally directed, transanal colonoscopic polypectomy, for patients who require polyp removal but in whose cases standard colonoscopic approach has failed is presented. The early results are excellent, and the method also can be applied to other patients who have colonic polyps who undergo procedures such as hysterectomy and cholecystectomy.


Bone scanning in carcinomas of the colon and rectum. Bone scanning has been shown to have a higher rate of accuracy in diagnosing osseous metastatic lesions from carcinomas of the lung and breast. In the present report, we have demonstrated this to be true for osseous metastases from carcinomas of the colon and rectum. We found that a high percentage (75%) of patients who have pelvic or back pain have positive 99mTc bone scans for metastases in spite of the negative radiographs. The previously reported incidence of 5-6% of osseous involvement from these tumors is probably lower than the actual incidence, as these studies were reported without the benefit of bone scanning.


Bupivacaine, a long-acting local anesthetic, in anorectal surgery. The long-acting local anesthetic, bupivacaine, was used in a series of 467 anorectal patients, both inpatients and outpatients. Bupivacaine was found to be safe and effective. Like other local anesthetics, it has none of the operative and postoperative complications frequently associated with general or spinal anesthetics. Its longer duration of action makes it extremely useful in anorectal operations on hospatilized and non-hospitalized patients. The potential hypertensive effects of using epinephrine in the local anesthetic solution appears to be negated by the calming, hypotensive effects of the intravenously administered sedatives in hospitalized patients.


Diazepam and local anesthesia in anorectal surgery. At the Ferguson Clinic, 161 anorectal procedures utilizing intravenously administered diazepam and lidocaine 0.5%, with epinephrine, 1:200,000, were done. Of the patients so treated 12% needed additional medication in order for anesthesia to be effective. No complication resulted from the use of these combinations. It is recommended that the combination of intravenously administered diazepam with local infection of lidocaine and epinephrine be given wider usage because of its ease of handling and very low complication rate.


Incarcerated diaphragmatic hernia: report of an unusual case. Traumatic diaphragmatic hernias, although quite common are frequently overlooked as a cause of intestinal obstruction. The hernia may produce significant symptoms acutely or manifest itself many years following the initial injury. A high index of suspicion is necessary to diagnose intestinal obstruction due to incarcerated diaphragmatic hernia. The operation should be performed through the transabdominal approach when hernia occurs acutely, and the transthoracic approach is recommended when herniorrhaphy is performed long after the time of injury. A case of incarcerated traumatic diaphragmatic hernia that occurred 19 years following a gunshot wound of the chest is reported. The intestinal obstruction was initially thought to be due to cancer of the splenic flexure of the colon.


Total anorectal reconstruction following congenital anorectal anomaly: report of a case. Following several unsuccessful postnatal attempts at anoplasty to correct anal atresia with a rectovaginal fistula, the patient, 20 years later, underwent an anorectal sphincteric construction using a gracilis-muscle transplant. The five-stage procedure, which extended over a period of two years, resulted in highly satisfactory continence and full social rehabilitation of the patient. The continence achieved in this case seems to be in contradiction to some of the accepted concepts of the mechanisms of continence.


Carcinoembryonic antigen in colorectal practice: report of three cases. CEA, in combination with the time-honored barium enema, sigmoidoscopy, rectal examination with guaiac determinations, and thorough clinical history, is a useful tool for the colorectal surgeon in following the progression of disease in both colorectal carcinoma patients and patients who have certain premalignant conditions. In this high-risk group of patients, CEA determinations as well as colonoscopy are becoming increasingly useful. That tumors on the left side are associated with higher CEA levels than those on the right side, due to vascular invasion or the grades of the tumors, and that often CEA antigenicity and severity of symptoms in ulcerative colitis correlate well, are emphasized. Finally, following total colectomy in five cases of ulcerative colitis, all CEA titers decreased to the normal range and have remained there.


L-dopa-carbidopa: combined therapy for the treatment of Parkinson's disease. It is now generally acknowledged that L-Dopa is the therapy of choice for Parkinson's Disease. However, L-Dopa has some short comings: It requires large daily dosage, the therapeutic benefits are achieved only after a delayed onset of 1-2 months, and it has a number of side effects both central and peripheral. In the last few years there has been an intense search for agents that are less toxic, more efficient and more rapidly acting that L-Dopa. The ideal agent has not yet been found. However, a combination therapy with L-Dopa and dopa decarboxylase inhibitors has shown promise. The decarboxylase inhibitors used have a large molecule which does not cross the blood brain barrier. Thus when L-Dopa and the decarboxylase inhibitor are given togehher, peripheral production of dopamine from L-Dopa is inhibited, therefore, rendering L-Dopa more readily and rapidly available for brain metabolism. In the present paper we present the results of the treatment of 50 patients on combined therapy using L-Dopa combined with Carbidopa.


Treatment of headache pain with auto-acupressure. Acupuncture techniques, primarily self-administered acupressure, were evaluated as symptomatic treatment for the pain of migraine, histamine cephalgia, and tension headaches. A twenty-four month study was conducted with a general neuropsychiatric outpatient practice of more than 500 patients, seen for more than 5000 outpatient visits; more than 200 patients had significant headache symptomatology. Appropriate pharmacologic, dietary and psychotherapeutic treatments were administered for underlying metabolic, neurologic and psychiatric disorders. The results of the study indicated that acupuncture techniques were reasonably effective in relieving the pain of migraine and tension headaches. Auto-acupressure replaced outpatient prescriptions for analgesics, ergotamine preparations, steroids, propanolol or methysgeride. The value of auto-acupressure was enhanced by its easy availability of application and lack of toxic effects.


Seizure disorders associated with neurosyphilis. Sixty-eight of 282 neurosyphilitic patients (24.1%) had repetitive adult onset seizures of unknown cause. Serum and CSF FTA-ABS were more accurate diagnostic tests than the non-treponemal serologic tests. The latter tests were reactive in only 54.5% of patients. In addition to standard anticonvulsants, the patients received 20-24 million units procain penicillin G IM during a three week period. The therapeutic failure rate among these patients was 17.3% in contrast to the nonsyphilitic patients who had 21.8-38.6% failure rates. The prognosis of seizures in GPI patients was the worst regardless of the form of treatment. The use of serum and CSF FTA-ABS is recommended as a part of diagnostic evaluation of adult-onset seizure disorders. The use of large doses of penicillin seems to improve the results of treatment.


Quantitative dimensions of alcohol use for hospitalized problem drinkers. Estimates of lifetime drinking quantities were obtained from two samples of hospitalized drinkers by personal interview. Estimates had high reliability and may significantly correlate with actual amounts. Group parameters for two samples were similar. Individuals show considerable differences from each other on all measures. Drinking quantities often remain stable from year to year, and the changes that do occur include both increases and decreases, usually by small amounts. There are occasional sharp increases in some subjects. The upper limits of drinking may be as high as three quarts of 1200 proof per day for a person over 200 lbs. There is great quantitative diversity among those labeled "alcoholic." It is more useful to view drinking within a quantitative continuum, and discard the presently accepted dichotomy which arbitrarily divides drinkers into the two classes of normal and abnormal. Drinking quantities would be associated with probable social and physical damage along the drinking continuum. It would not be necessary to view those at the extreme of the continuum as qualitatively different from other drinkers, but as quantitatively different. The relationship between quantity and the adverse consequences of drinking are not simple. The harm that any quantity of alcohol can cause may depend also on other factors. Drinking may be viewed as a learned behavior that is a response to on-going events within the person's environment, rather than a symptom of an underlying disease process. It is regulated like other conditioned behaviors by the effects which it produces. The occurrence of this persistent non-adaptive behavior can be explained by the principals of learning theory, making it unnecessary to suppose an underlying disease process to account for such behavior.


Clinical use of tricyclic antidepressants. Tricyclic antidepressants are extremely valuable drugs when they are used in suitable patients, principally those suffering from endogenous depressions. Diagnosis of depression is of major importance in determining the nature of treatment to be used. Differences between most tricyclics are minor for the most part, involving different degrees of sedative or anticholinergic properties. With the exception of doxepin, they are about equally effective in blocking the amine pump mechanism, which is believed to be the pharmacologic action most pertinent to their antidepressant action. A wide range of dose must be explored if patients are to be treated properly. For the most part, doses are defined empirically, either by alleviation of depression or by intolerable side effects. Dosage schedules should be flexible initially but during therapeutic and maintenance periods, single daily doses are possible. Maintenance doses should be reduced to the lowest consistent with continued relief. Treatment should be brief if the episode of depression is the first and is not severe, but may be prolonged for years in patients with a history of frequent and severe recurrences of depression. Other drugs may sometimes be required, and psychological approaches to treatment are always required. ECT should be available for selected instances of severe depression. The hazards of tricyclics are well known and generally are extensions of known pharmacologic effects. Careful prescribing of these drugs can minimize the consequences of suicidal or accidental overdose.


Minimal brain dysfunction: a hydraulic parfait model. A Venn diagram shows the overlap of MBD, behavior disorders, and learning disorders. A hydraulic parfait model illustrates a concept of symptom production by additive accumulation of pathology from various etiologies. This implies a psychophysiologic disorder. It also implies a multidimensional spectrum of etiologies which could be important for treatment plans in individual cases. A similar hydraulic parfait illustrates a concept of diagnosis-triggering by cumulative pressure from various symptoms. Diagnosticians form a spectrum of "trigger pulls", from "hair trigger" to "on safety." A useful research effort might be to find a convenient means of developing etiological profiles for individual patients, perhaps by correlation with symptom spectra.


Towards a systems definition of psychiatric practice. Assessment of psychiatric practice has been difficult largely because of the apparent diversity of psychiatrists' theories, procedures, and goals. Searching for a unifying principle, we propose system identification failure (SIF), a defect in data-processing, as the unit of psychopathology underlying all psychiatric disorder (and other behavioral error). Definitive treatment must not only identify and correct the data-processing defect, but also eliminate the secondary symptoms. Emphasis is not on method of treatment but on goal or intent. Preparatory treatment includes supportive psychological and environmental measures and somatic therapies (regardless of type, duration, or intensity) which make definitive treatment possible. Palliative treatment must be frequently reviewed. Preventive treatment should prevent SIF-formation. We consider our proposal a distillate of the aims and implicit intent of experienced psychiatrists regardless of their training or theoretical orientation. The search for a functional definition of the practice of psychiatry was perhaps at one time an academic or lexicographic exercise, but, with the advent of peer review, it has become a pragmatic matter deserving of earnest attention. What is psychiatric practice? In a universe criss-crossed by psychiatrists "riding madly off in all directions." not only are the descendants of Anna O. and Dora analyzed in vivo and those of Little Hans at one remove, but also are distant figures and cultures subjected, often iv vitro, to critical scrutiny, while the "talking treatment" is applied to couples, families, groups, "networks" and communities. When one adds to this the diversity of biological therapies and institutional, environmental, and behavioral manipulations, the task of finding a common theme, much less procedure, becomes a worthy problem in hermeneutics, general semantics, or system analysis. Thus we must ask not only the operational question, "What do psychiatrists do?" BUt also, "What did you to to treat the specific psychopathology of this patient?" "Did it work?" AND, "Hos do you know?" Failure to deal with such questions as these will mark psychiatry's inability to cope with a reality that includes Professional Standards Review Organizations and an imminent National Health Insurance...


[Effect of saralasin on normal blood pressure and on reno-vascular hypertension (author's transl)]. The angiotensin antagonist saralasin was given intravenously to six normotensive students before and after dietary sodium restriction and to two patients with renovascular hypertension. Both patients responded to the angiotensin antagonist with a decrease of the systolic (32 and 38 mm Hg) and of the diastolic (29 and 16 mm Hg) blood pressure. The small changes in blood pressure observed in the normotensive subjects during the infusion of the angiotensin antagonist indicate that angiotensin II plays no important role in the control of normal blood pressure in recumbent men. The fall in blood pressure induced by saralasin in both patients, however, demonstrates that their hypertension was at least partly angiotensin-dependent. Renal vein renin determination led to the same conclusions. The saralasin infusion test seems to be a simple procedure to diagnose angiotensin-dependent hypertension and will probably help to identify patients with suspected renovascular hypertension.


[Treatment of hyperlipoproteinaemia types IIa, IIb, IV and V with a combination of clofibrate and inositol nicotinate (author's transl)]. Treatment of 14 patients over eight weeks with a combined preparation containing 250 mg clofibrate and 180 mg inositol nicotinate resulted in a decrease of serum-cholesterol level of 20% and of serum triglyceride levels of 40%. The same effect was obtained in 22 patients by clofibrate alone in double doses. There was no significant difference in effect between the two preparations. Doubling the dose of the combined preparation in ten patients did not increase the lipid-lowering effect. After the combined preparation had been stopped triglycerides rose more slowly than after stopping clofibrate alone. There was no difference with regard to the rise in the cholesterol levels. The combined preparation lowered serum lipids regardless of the type of hyperlipoproteinaemia, but the extent was less with types IIa and IIb (n =15) because of the lower initial value, than in those with types IV (n = 26) and V (n = 3).


[Haemoglobin M-Homburg (author's transl)]. Haemoglobin M is a rare cause of congenital cyanosis and is usually misdiagnosed as being due to congenital heart disease. This was also the case in a family on whom this report is based. In five members of three generations the characteristic grey-blue cyanosis was due to a haemoglobin M anomaly. In all of them cardiopulmonary disease, anaemia and haemolysis had been excluded. The amino-acid substitution was in the alpha-chain of the globin molecule. Consequently the carriers of the trait have an abnormal haemoglobin content of 20-25%. Despite marked cyanosis they feel well.


[Leucocyte migration-inhibition test in syphilis (author's transl)]. The leucocyte migration-inhibition test was performed on blood from 57 patients with syphilis. Even in the early stages of the disease with lymph-node involvement there were signs of cellular antitreponemic reactivity. But there was an absence of cellular immune response in some patients with secondary syphilis and CNS involvement in the course of tertiary syphilis.


[Haemoperfusion with activated charcoal and ion exchanger in phalloidin intoxicated rats (author's transl)]. Amberlite-XAD-4 and activated charcoal haemoperfusion permit a considerable increase in 14C-methyl-phalloin elimination in vitro which surpasses the effect of haemodialysis treatment. However, in the in-vivo experiment using phalloidin intoxicated rats (1.5 or 2.0 mg/kg i.v.) prolongation of the survival period could not be attained 0y haemoperfusion.


[Occult blood in stool. A field trial in cancer screening (author's transl)]. 4000 male probands aged 45 to 69 were investigated in a field trial according to random distribution for undetected intestinal bleeding with the Haemoccult - method. With a participation of 28% only 39 out of a total of 65 positive cases could be evaluated. Four cases of colon or rectal carcinoma and four cases of colonic polyps were ascertained. In view of complete lack of experience with false negative test results the Haemoccult test is at present a useful addition to the diagnostic possibilities. However, in suspected cases even a repeatedly negative test cannot replace complete colo-rectal investigation.


[Clinical course of arteriosclerosis of coronary and lower limb arteries (author's transl)]. The clinical course of arteriosclerosis was evaluated in 9 patients with coronary sclerosis and in 25 with peripheral arterial occlusive disease by means of repeat angiographies following primary angiography after 22.5 and 36.6 months, respectively. During the period of observation arteriosclerosis had progressed in all cases except in two patients with peripheral arterial occlusive disease. Despite intensive therapeutic efforts including control of risk factors, dietary care, guided or unguided exercise and the attempt to change unsatisfactory living conditions, progression of arteriosclerosis could not be interrupted. If treatment delayed progression of arteriosclerosis cannot be decided. All vascular areas were affected indiscriminately by progression and no particular localisation was preferred. Intensive exercise does not seem to delay progression of arteriosclerosis.


[The influence of coffee and caffeine on gastrin and acid secretion in man (author's transl)]. Intragastric instillation of coffee, decaffeinated coffee and pure caffeine in humans significantly stimulated gastric secretion. After intragastric caffeine, basal serum gastrin concentrations were not changed. However after instillation of coffee and decaffeinated coffee serum gastrin increased significantly. Thus acid secretion was significantly greater after coffee and decaffeinated coffee than after caffeine. Roasted products seem to be responsible for the gastrin-releasing effect of coffee.


[Indications and limitations of mammography in the diagnosis of breast tumour (author's transl)]. Malignancy of a palpable, circumscribed, solid breast tumour can be clarified only by diagnostic extripation and subsequent histological examination. None of the known physical methods approaches the histological examination in diagnostic accuracy. Since, however, diagnostic accuracy is as important here as with every form of malignant tumour, mammography is superfluous in case of palable tumour. If results of mammography and palpation are equivocal, it must be decided whether histological examination or expectant waiting for a specified period with serial controls is necessary. The fact that "small" carcinomas can be removed surgically may put the patient at risk if this procedure is practised too widely for cosmetic reasons or in the belief that this is sufficient. Yet radical removal is the cardinal requirement in operations for carcinoma of the breast. Radical operation with complete removal of the axillary lymph nodes is thus not a retrogressive step.


[Incidence of locally confined growth of carcinoma of the breast (author's transl)]. In 220 cases of breast carcinoma with an anatomical size of less than 2 cm metastases outside the primarily affected quadrant could be demonstrated in the remaining breast in 23.6% of cases (n = 52). Axillary lymph node metastases were present in 3.93% (n = 86). With a tumour size up to 0.5 cm neither metastases in remaining breast tissue nor lymph node metastases could be found. With a tumour size of 0.6 to 1.0 cm only 32 out of 51 cases (62.7%) could be considered to be locally confined. In tumours between 1.1 and 2 cm there was no spread demonstrable in remaining breast tissue or axillary nodes in 70 out of 164 cases (42.7%).


[The influence of warm ischaemic time on the results of hypothermic kidney perfusion (author's transl)]. 50 dog kidneys were mechanically perfused under hypothermia for between 12 and 72 h and then transplanted. Before perfusion the kidneys were subjected to 15,30,45 and 60 min of warm ischaemia: 15 min of warm ischaemia were well tolerated (successful 72-h preservation), but after 30 min preservation was successful for only 24 h. Enzyme release and lactate formation depended on the duration of warm ischaemia. Furthermore, these perfusate concentrations indicated the viability of the organ (highly significant differences between well functioning kidneys and those with little or no function.


[Diagnosis of internal carotid artery obstructions (author's transl)]. The diagnostic value of directional ultrasound Doppler-sonography (UDS) of the supratrochlear (medial frontal) artery was evaluated by examination of 191 angiographically controlled cases in whom a carotid obstruction was suspected. A systematic compression of the facial and temporal arteries of both sides was performed. In 108 cases the UDS findings were normal, 6% of these were false negative and actually had a stenosis (n = 6) or occlusion (n = 2) of the internal carotid artery. In 88% of the pathological findings a stenosis (n = 39) or occlusion (n = 34) of the internal carotid artery was revealed by angiography. 79% of the stenoses were of severe degree (more than 50%). These results show that UDS is a useful diagnostic tool for the detection of severe stenoses or occlusions of the internal carotid artery. A distinction between stenosis and occlusion by UDS of the supratrochlear artery is, however, not possible, unless additional examination of the carotid arteries is performed. The method is not suitable for the detection of low grade stenoses.


[Guinea-pig asthma (author's transl)].

[Guinea-pig asthma (author's transl)]. Out of 140 selected patients with bronchial asthma 24 demonstrated signs of guinea-pig hypersensitivity. Six further patients with a shorter exposure to guinea-pigs were not sensitized. The diagnosis can be established by means of history, skin test, and removal of the animal. The mean period until asthma became clinically manifest was 12.3 months, for the prodromal stage rhinitis and (or) conjunctivitis 9.8 months. Atopic symptoms may or may not be present in affected persons. A great number of accompanying false-positive skin test reactions to different animal dander antigens supports the hypothesis of an antigenic relationship between dander allergens from different animal species. The only treatment for guinea-pig asthma is removal of the guinea-pig. Other domestic animals should be avoided as well.


[Mineral content of bone in long-standing diabetes: densitometry of "diabetic osteopathy" (author's transl)]. Using 125I-photon absorption, skeletal mineral content was measured in 57 diabetics requiring insulin. Average age was 33 years, mean duration of diabetes 19 years. Abnormally reduced mineral content was detected in ten of 21 males and 11 of 36 women. This finding is interpreted as being a late complication of diabetes. Pathological fractures were not seen and there were very few complaints referable to the skeletal system.


[Innervation anomalies of the  thenar muscles (author's transl)]. In 337 patients various reasons led to an electromyographic investigation of the thenar muscles and frequently of the hypothenar muscles as well. Conduction velocity studies of the median and ulnar nerves were also performed. Five cases were found with concomitant innervation and two cases with exclusive innervation of the opponens pollicis muscle by the ulnar nerve. Two clinical cases in whom a severe median nerve injury has been overlooked due to this anomalous innervation demonstrate the importance of the awareness of this innervation variation.


[Severe coagulopathy due to inhibitors of several clotting factors in IgM paraproteinaemia (author's transl)]. A 62-year-old man presented with an IgM paraproteinaemia and then suddenly developed an haemophilia-like haemorrhagic diathesis. Clotting tests revealed markedly prolonged Quick prothrombin times (more than 2 min) and much diminished factor II, V, VII, and X activities. Cross-mixing experiments indicated the presence of a circulating inhibitor, which specifically blocked the activity of these factors. But the exact mechanism remains uncertain, no inhibitor of this type having been previously reported. In addition to the clotting defect there was a probably monoclonal immunoglobulin IgM. Complete remission occurred and has now persisted for 18 months, after immuno-suppressive treatment with azathioprine and prednisone. It is suggested that the inhibitory capacity is confined to the abnormal IgM, due to a primary immunological disorder. A review of similar reported cases emphasizes the importance of immunosuppressive treatment in this disorder.


Spatial vector changes during ventricular depolarisation using a semi-orthogonal lead system--a study of 190 cases. The paper describes the spatial vector changes during ventricular depolarisation in 190 horses using a semi-orthogonal ECG lead system. The replacement of planar vector loops by a plot of 3 parameters to depict the changing spatial vector, with a time base on the X axis, is described and illustrated. Some horses with diastolic murmurs and some with a history of respiratory problems formed 2 distinct groups. As a result of these findings a possible relationship between the vector changes and the anatomical siting of the ventricles is suggested and discussed. Attention is drawn to certain measurements which appear to have possible use in assessing the significance of cardiac electrical activity in relation to changes in the ventricular myocardium.


The surgical treatment of fractures of the olecranon in the horse. Methods of treating fractures of the olecranon in the horse are reviewed. A further 4 cases are recorded in which the fracture was treated by open reduction and fixation with a heavy duty Venable's plate placed on the caudal aspect of the ulna. Three cases had an oblique fracture through the semilunar notch; this was complicated in one by a fracture of the lateral half of the radial head which resulted in subluxation of the radio-humeral joint. The fracture of the radial head was treated by open reduction and fixation with a lag screw. The fourth case had an oblique fracture of the olecranon just proximal to the semilunar notch, complicated by a fracture of the anconeal process which was removed. The fractures healed within 10 weeks and the plates were removed in all 4 cases. During follow-up periods ranging from 10 to 26 months, all 4 animals became sound.


Behaviour of the heart rate of horses with auricular fibrillation during exercise and after treatment. Cardioversion through varying quinidine sulphate treatments was achieved in 3 riding horses with auricular fibrillation. The horses were subjected to continual telemetric ECG registration before and after reversion in a uniform exercise-tolerance-test. A comparison of the heart rate curves showed a strong decline of the heart beat frequency during the exercise phase after synchronisation. The decrease in heart rate during exercise was greater than 30% in all 3 patients. Anti-arrhythmic treatment is, therefore, recommended for horses with auricular fibrillation and without concurrent heart disease.


Studies on erythrocyte metabolism following acute blood loss in the horse. Anaemic horses do not provide reticulocytes during an erythropietic response. Acute blood loss was studied in 4 ponies as a model to monitor changes in erythrocyte metabolism during active erythropoiesis. Following phlebotomy, erythrocyte adenosine-5-triphosphate, adenosine-5-diphosphate, glucose-6-phosphate, fructose-6-phosphate, and phosphoenolpyruvate increased signifcantly. The remaining glycolytic intermediates did not change. It is suggested that the determination of erythrocyte adenosine-5-triphosphate may be used to evaluate erythrocyte response following acute blood loss in the horse.


Isometric strength and endurance during the menstrual cycle. Seven healthy young women, 3 whom had been taking oral contraceptives, were examined during the course of 2 menstrual cycles to assess their isometric strength, their endurance during a series of 5 fatiguing isometric contractions at a tension of 40% MVC, and their blood pressures and heart rates during those fatiguing contractions. Two sets of experiments were performed, one in which the subject's forearm temperature was allowed to vary as a function of T A, and one with the muscle temperature stabilized by immersion of the forearm in water at 37 degrees C. During exposure to ambient temperatures, isometric strength and both the heart rate and blood pressure responses at rest and at the end of a fatiguing, sustained isometric exercise, were not significantly different during any phase of the menstrual cycle in any subject. In contrast, the isometric endurance in the women not taking oral contraceptives varied sinusoidally in all 5 contractions with a peak endurance midway through the ovulatory phase and the lowest endurance mid-way through the luteal phase of the menstrual cycle. The isometric endurance of the women taking oral contraceptives did not vary during their menstrual cycle. After stabilization of the temperature of the muscles of the forearm in water at 37 degrees C, the isometric endurance of the normal subjects showed a hyperbolic response with the maximal endurance at the beginning and end of their cycles, and the shortest endurance at mid-cycle. Here again, however, the isometric endurance of the women taking oral contraceptives did not vary after immersion of their forearms in the 37 degree C water.


An apparatus and a method for measuring the relationship of triceps surae torques to tibio-tarsal angles in man. 1. The apparatus and method described give the relationship of triceps surae torque to the absolute tibio-tarsal angle. Data of the anatomy of the foot and the axis of the ankle are taken into consideration. They make complementary measurements necessary, which in certain cases enable the angle recorded by the apparatus to be corrected so as to obtain the true angle. 2. The reliability of the apparatus and the technique of linkage of subject to apparatus are judged by examination of the torque-angle plots obtained by passive stretching of the triceps in 7 subjects for whom correction is monor. Good reliability was observed during the session and from one session to another. The plot is exponential. The merits of the method of correcting angles are illustrated in three subjects with the same protocol: when plots are not corrected, they are more dispersed during the session and no longer exponential. These results justify the considerable correction of the angle that we propose in the study of isometric contractions.