[Procedures for the early recognition of diabetics in Basle 1972. Contributions to the early diagnosis of diabetes mellitus by means of blood sugar analysis with special reference to the practical procedures under Swiss conditions]. In Basle in 1972 a diabetes survey was performed in subjects with increased risk of diabetes mellitus (overweight, age above 50, relatives of diabetics). For screening, the blood sugar was determined one hour after ingestion of 50 g of glucose. 404 males and 768 females (known diabetics excluded) were examined. One third of males and one quarter of females had a blood sugar value above 150 mg%. Blood sugar values of more than 200 mg% were found in 9% of the male and 7% of the female participants. A positive correlation existed between age and blood sugar values in males and females. Body weight and blood sugar value correlated only in females. However, in male subjects with pronounced obesity (Broca index greater than 1.23) there was a significantly higher incidence of blood sugar screening value above 150 mg% than in the rest of the males. It would appear that even slight overweight enhances glucose intolerance in females, whereas in males only marked overweight favours the manifestation of glucose intolerance. The cost of the detection of a new case of diabetes mellitus (blood sugar greater than 200 mg%) amounted to Sfr. 70.-. The Basle diabetes survey provides a model for successful conduct of a preventive program through cooperation of private organizations such as the local Medical Association and the local Diabetes Association.


[Extranodular manifestations of generalized malignant lymphomas]. 90 cases of malignant lymphoma in the autopsy material of the Institute of Pathology, University of Zurich (1970-1974) have been analyzed with reference to extranodular manifestations. 8% of the malignant lymphomas showed primary extranodular manifestations. The organs involved were (in decreasing order of importance) spleen, bone marrow, liver, kidneys, central nervous system, pancreas, adrenal glands, skin, lung and stomach. In 12% of cases only the lymphnodes were affected, whereas in the rest of the cases (80%) lymphnodes as well as extranodular organs were involved. In 78% of the malignant lymphomas the disease had had its origin in a solitary lymphnode or in a group of lymphnodes, the cervical lymphnodes predominating (30%). In 22% of the cases, extranodular organs (primarily the intestinal tract) had been the site of the primary clinical manifestations. The average time of survival was 17 months, including all grades of differentiation of the proliferating tumor cells. For the more unfavourable reticulum-cell type of malignant lymphoma the corresponding period was only 12.5 months.


[Frequency of amebiasis and other intestinal protozoal diseases. An epidemiological study with the aid of MIF technic]. Advantages and disadvantages of various laboratory techniques used for the diagnosis of intestinal protozoa are discussed. The importance of a correct parasitological diagnosis is emphasized. The MIF procedure has been investigated with regard to its reliability and found to be very effective due to its high diagnostic yield and reproducibility in repeated examinations. The incidence rates found in our material agreed well with those in the literature, thus enhancing the value of the MIF procedure. The feces of 1005 persons returning from the tropics during the first 8 months of 1975 have been examined by the MIF technique and assessed for intestinal protozoa. Apathogenic amebae were found four times as often as E. histolytica. The incidence was 52.7/1000 for E. histolytica and 70.6/1000 for Giardia lamblia. Multiple parasitosis is often diagnosed. E. histolytica is very likely to be encountered when two or three apathogenic amebae are present.


[Surgical treatment of acute pancreatitis]. In the initial stage the treatment of acute pancreatitis must be medical. If there is not positive improvement after 2 to 6 days or in cases of associated cholelithiasis, surgery is indicated. The first step in surgery is a search for necrosis and hematomas, and their exact topographic localization. These findings will determine the final tactics, which may be drainage only, partial or exceptionally, total resection, or necrosectomy (which is not to be confused with a sequestrectomy !). Indications for these different types of operation are outlined and discussed. They are supplemented by large-scale drainage/lavage of the abdomen, choledocostomy or at least cholecystostomy, and temporary exclusion of the upper portion of the digestive tract. 30 personal cases treated according these principles are discussed.


[New therapeutic acquisitions in the surgery of the liver and bile ducts]. During these last years, there has not been sensational changes in biliary surgery, but rather a progressive improving of already known procedures. Conversely, the surgery of the liver has had a remarkable evolution. Even without mentioning transplantation, the possibility of resecting large parts of the gland with a reasonable risk demonstrates the progresses done these thirty last years. It is probable that technics introduced by liver transplant teams, such as bloodless resection by cold perfusion in situ, will allow to go even further in subtotal liver resection.


[Malabsorption].

[Malabsorption]. Various forms of malabsorption may be differntiated by quantitiative determination of fats, nitrogen and lactic acid in feces. Increased excretion of lactic acid may also be caused by bacterial degradation of intestinal mucus.


[Effects of the environment on the liver and gastrointestinal tract]. The liver has a central role in the detoxication and elimination of toxic substances which enter the body as lipid-soluble compounds. Their transformation into polar watersoluble metabolites, termed biotransformation, is bound to the membranes of the smooth endoplasmatic reticulum. The oxidating enzyme in biotransformation can be induced by certain toxins and drugs. The chronic induction of enzymes by DDT and the consequences of this process of adaptation, particularly in regard to the metabolism of calcium is discussed. The protective effect of biotransformation and induction of enzymes against carcinogens, especially aflatoxin, are briefly reviewed. As examples of the chronic influence of vasotoxic substances, mention is mode of the veno-occlusive disease caused by the alkaloid phlorrhizidin found in plants, and the vinyl-chloride disease occurring in workers handling PVC. The first leads to portal hypertension of the post-sinusoidal type, while the second leads to pre- or intrasinusoidal portal hypertension and, after years of exposure, to hemangioendotheliosarcoma of the liver. The same tumor has been observed after arsenic intoxication. Arsenic may also lead to non-cirrhotic portal hypertension. The present opinions about environmentally induced gastrointestinal diseases are widely hypothetical. The high frequency of gastric carcinoma in Japan. and the varying occurrence of carcinoma of the colon in the civilized world in comparison with the rural population of tropical regions, is emphasized. The explanation for these facts is probably to be sought in differences of nutrition.


[Can results in modern colonic surgery be improved? The results of 600 surgically treated colonic neoplasms]. Postoperative examination of 600 patients with carcinoma of the large bowel showed: 1. in emergency operation mortality is 30%, in elective surgery 10%; 2. operation risk in elderly patients is not significantly higher than in young patients; 3. only a decrease in "patient and doctor delay" and/or mass screening will provide better results.


[The hemoccult test in the screening for colonic carcinoma]. The only practicable method for mass screening for carcinoma of the colon is detection of occult blood in stool. In a coloscopically controlled study with the Haemoccult test, dependent from diet, 54-66% of polyps and 77-100% of carcinomas were detected. The Haemoccult test is therefore a suitable method for mass screening for colon carcinoma.


[Calcitonin and salivary gland amylase secretion in vivo and in vitro. Preliminary report]. Synthetic human calcitonin stimulates amylase secretion of salivary glands in man. The same effect has been demonstrated in isolated cells of rat salivary glands. In vitro experiments suggest that the stimulatory effect is a direct action of calcitonin on salivary cells. Salivary secretion is not affected by pancreozymin or secretin. Our findings afford another example of the difference in secretory behaviour between salivary glands and pancreas.


[Is the "exponential fitting" in the stomach emptying curve justified?]. Gastric emptying of a solid meal labelled with 1 mCi99mTc-sulphur colloid has been studied with a gamma camera and computer in 5 healthy volunteers. The emptying process was analyzed for the three periods 0--30 min, 45--75 min, and 90-120 min after ingesting the meal. The half emptying time (T1/2) was calculated by exponential fitting for the three periods separately and an anlysis of variance of the regression slopes was performed. The nil hypothesis of no difference between the T1/2 calculated from the three periods was rejected at a level of significance of 0.01 in 13 out of 14 experiments. The authors discuss the practical implications of these findings for the use of T1/2 in the study of gastric emptying with labelled test meals.


[Behavior of serum gastrin under vagus stimulation with 2-deoxy-D-glucose with special reference to acid secretion and the mucosal histology]. Administration of 2-DG accompanied by simultaneous neutralization of gastric contents with sodium bicarbonate resulted in a rise in serum gastrin in 4 patients without gastric disease, 4 with duodenal ulcer and 4 with gastric ulcer. The rise in gastrin equals that observed on stimulation with meat extract. Patients with gastric ulcers display a low PAO and a small rise in gastrin compared with normals and patients with duodenal ulcers. This finding correlates well with the chronic atrophic changes of the antral mucosa in patients with gastric ulcer.


[Effects of proximal gastric vagotomy (PVG) and total vagotomy (TV) on the coordination of the interdigestive myoelectric acitivity of the canine stomach and duodenum]. Interdigestive myoelectrical activity of the canine stomach and duodenum is organized in complexes of high-amplitude action potentials originating simultaneously in the stomach and duodenum every 80-180 minutes. This type of activity has been described as the "interdigestive myoelectrical complex" (IDMEC) by Szurszewski. The present work was undertaken to elucidate the role of the vagus nerve in control of the IDMEC. Dogs were prepared with chronically implanted Ag-AgCl-electrodes on the stomach and duodenum. Fasting myoelectrical activity was recorded in the normal animal, after proximal gastric vagotomy (PGV), and after truncal vagotomy (TV). PGV did not affect the IDMEC, but TV abolished the pattern for the period of observation (3 months). The authors discuss the possible role of interference by TV with gastrodeuodenal interdigestive motor activity in the pathogenesis of reflux gastritis after vagotomy and drainage.


[Exocrine pancreatic function, intestinal resorption and reaction to Vibrio cholerae infection in protein deficiency]. Six Patas monkeys were fed a protein-free diet while 16 animals of the same species receoved a standard monkey diet. The protein-depleted monkeys showed reduced absorption of folic acid but not Dxylose, and 5 out of 6 exhibited depressed exocrine pancreatic function. When challenged with Vibrio cholerae, animals with reduced folic acid absorption and pancreatic enzyme production excreted the micro-organisms for a longer time.


[Delay in the diagnosis of stomach neoplasms: consequences in 534 cases]. "Patient delay" in carcinoma of the stomach has been, in the past 10 years, 4 months on average. However, "doctor delay" has increased from 10 weeks to 8 months. A shortening of "doctor delay" is possible only if early endoscopy is carried out.


[The use of impedance measurements in the colon]. Biological changes in tissue also affect its biophysical and consequently its electrical properties. By the method here described, high-frequency current is caused to flow through the tissue under examination and the voltage decrease is measured. Measuring equipment of the author's own design has been developed for routine use of the method. The results of repeated measurements in the rectum of 323 subjects show that malignant tumor always cause lesser voltage decreases than do intact or inflamed tissues. The method has already been used during coloscopy in 40 patients. The results were in full agreement with biopsy findings.


[The value of endoscopic retrograde cholangiopancreatography in negative or undetermined cholecystocholangiography]. In 299 patients with negative cholecystocholangiogram, endoscopic retrograde cholangio-pancreatography (ERCP) was performed. In obstructive jaundice ERCP is the method of choice, while in cholestasis it is indicated if the intravenous cholecystocholangiogram is insufficient. In unclear abdominal conditions and in "postcholecystectomy syndrome" ERCP may be carried out after other abdominal diseases have been ruled out.


[Diagnosis of treated and untreated chronic-aggressive hepatitis]. A total of 121 patients with chronic active hepatitis (CAH) of two Zurich hospitals were controlled over a mean time of 5 years and 4 months. All patients of one hospital were consequently treated with corticosteroids and azathioprine, whereas those of the other hospital were not treated unless a severe deterioration occurred. In this case treatment was as short as possible. Results indicate that long - time treatment of CAH results in better prognosis than does no or short - time treatment. Death rate per observed patient - year was 0.079 in the no - therapy group, 0.035 in the short - therapy group and 0.025 in the long - time therapy group.


Oxprenolol in hypertension: a report on 2,770 patients in general practice originally treated with methyldopa. Substitution, in part of totally, of the non-selective beta-receptor antagonist oxprenolol for methyldopa in 2,770 treated hypertensive patients resulted in a significant reduction in blood pressure levels and a considerable improvement in the quality of the patient's life.


Detection of breast disease in a family planning association clinic. The incidence and prevalence of disorders of the breast have been assessed in 13,456 women examined annually at a family planning clinic over 5 years. Screening for disorders of the breast was by clinical examination alone and abnormalities were detected in 1 of every 58 women attending the clinic and these were referred for hospital opinion: biopsy was required in 1 in 114. Only 12 cancers of the breast were detected and all of these in women over 35 years. It is suggested that the usual policy of examining the breasts of women taking oral contraceptive preparations should be restricted to those over 40 years.


X-ray microscopy of biological objects with carbon kappa and with synchrotron radiation. X-ray micrographs of biological objects have been obtained with a resolution better than 1000 angstroms by using poly(methyl methacrylate) x-ray resist and carbon Kalpha or synchrotron radiation. Synchrotron radiation allows short exposure times; storage rings especially designed as radiation sources and improved x-ray resists would make exposure times under 1 second possible.


Opsin structure probed by raman spectroscopy of photoreceptor membranes. The first nonresonance Raman spectra of photoreceptor membranes are presented. Information about the membrane protein, opsin, and the membrane phospholipids can be deduced. Opsin appears to contain alpha-helical structure but little beta structure. The tyrosine residues are predominantly hydrogen bonded, and disulfide bonds, if they are present, are not in the normal gauche-gauche configuration.


Lateral preoptic lesions in rats separate urge to drink from amount of water drunk. Rats with bilaterally symmetrical lesions in the laterla preoptic area do not drink after acute intracellular dehydration, but they drink normally after water deprivation. They, like normal rats, also drink more when cellular dehydration is superimposed upon water deprivation. Unlike normal rats, however, rats with lesions in the lateral preoptic area do not increase their rate of lever-pressing in response to the combined stimulus. Thus, the urge to drink can be separated from the amount of fluid drunk.


Human Y-chromosome-specific reiterated DNA. Radiolabeled reiterated DNA specific for the human Y chromosome has been obtained by extensive reassociations between [3H]DNA prepared from men and excess DNA from women. These highly purifed labeled sequences reassociate only with DNA from individuals with a Y chromosome. The percentage of Y-chromosome-specific DNA isolated from individuals with differing numbers of Y chromosomes is a function of the number of chromosomes present. The purifed Y-chromosome-specific sequences may represent between 7 and 11 percent of the human Y chromosome.


Elimination of the sarcoma genome from murine sarcoma virus transformed cat cells. Cat cells transformed by Moloney murine sarcoma virus contain virus-specific sequences in their RNA and DNA. Cloned, spontaneous revertant cell lines derived from clones of these cells had no evidence of the sarcoma genome in the cell RNA or DNA as judged by RNA-complementary DNA or DNA-complementary DNA hybridizations. ?This is apparently the first report of loss of a transforming genome in a revertant cell line.


Prostaglandin B1: the L-shaped prostaglandin. The crystal and molecular structure of prostaglandin B1( PGB1) has been determined. The conformation is L-shaped, with the alpha and omega side chains roughly perpendicular to one another. This arrangement differs from the "hairpin" or approximately parallel disposition of side chains observed for other prostaglandins. The omega chain, which normally turns at the 15-hydroxyl back toward the alpha chain, is fully extended. The conformation is stabilized by the conjugation of the dienone chromophore. The 15-hydroxyl, which is normally directed away from the centroid of the prostaglandin in the hairpin model, is turned inward in L-shaped PGB1. The low biological activity of PGB1 in many systems and especially its inhibition of the metabolizing enzyme 15-hydroxyprostaglandin dehydrogenase may be attributable directly to the observed L-shape conformation.


Both positive reinforcement and conditioned aversion from amphetamine and from apomorphine in rats. Rats learned to press a lever for intravenous injections of amphetamine or apomorphine. They also learned to avoid the taste of saccharin which was associated with experimenter-administered amphetamine or with self-administered apomorphine. Thus these, and  presumably other, self-administered drugs serve as compound pharmacological stimuli, having both positively reinforcing and aversive properties.


Marine oscillatoria (Trichodesmium): explanation for aerobic nitrogen fixation without heterocysts. Nitrogen fixation in marine Oscillatoria appears to be associated with differentiated cells located in the center of the colony. These central cells exhibit reduced pigmentation relative to peripherally located cells and do not incorporate 14CO2 in photosynthesis. Central cells apparently do not produce O2 which would deactivate nitrogenase. When central cells are exposed to O2 via disruption of the colonies, N2 fixation (acetylene reduction) decreases sharply even though individual trichomes remain intact. Disruption of colonies in the absence of O2 does not cause reduced nitrogenase activity. In the sea, turbulence from wave action apparently separates trichomes allowing O2 to enter thus decreasing nitrogenase activity. These observations explain how Oscillatoria is able to fix N2 without heterocysts in an aerobic environment and why it blooms virtually always occur in calm seas.


Pattern-analyzing memory.

Pattern-analyzing memory. College students reread text after an interval of 13 to 15 months more rapidly than they read new matter taken from the same sources. The results implicate a memory system at the level of pattern analysis that seems to be distinguishable from memory of syntactic and semantic features of text.


beta-D-galactosidase activity in single yeast cells during cell cycle of Saccharomyces lactis. Single Saccharomyces lactis cells taken from a random population were assayed for beta-D-galactosidase activity under a microscope equipped for fluorogenic measurements. The cells were also photographed, and enzymatic activity was correlated to the size of cell buds. A perodic pattern of enzyme synthesis was found during the cell cycle.


Meaning, memory structure, and mental processes. Although people experience little difficulty in recognizing printed words and comprehending sentences, they cannot do it instantaneously. Experimental psychologists have recently measured the speed of these mental processes by applying a reaction-time method. The method provides new data concerning the organization and retrieval of familiar semantic information in human memory. It has been found that close relations between the meanings of words help people to recognize and pronounce the words faster, especially when the words are hard to see because of visual distortions. Close relations between word meanings also facilitate the comprehension of some sentences, as indicated by how long a person takes to decide whether the sentences are true or false. The facilitation is not universal, however. When the relation between the meanings of two words must be analyzed carefully, their proximity may actually inhibit mental processing. These results, along with additional findings, support the hypothesis that human memory includes a semantic network that represents various categories of objects at distinct locations linked to specify their relations with each other. The memory structure probably influences a number of different mental processes that use it. One possible access route to the network is through a set of detectors designed to accumulate sensory information and signal the presence of particular words. There also appear to be processes for searching and comparing pieces of knowledge after a person finds the memory locations of designated categories. Further research using the reaction-time method may provide a more detailed inventory of what facts are retrieved directly from memory and what are computed from other stored information (36).


Sex pheromone specificity in the pine sawflies: interchange of acid moieties in an ester. 3,7-Dimethylpentadecan-2-ol was identified as the free alcohol in three species from two genera of pine sawflies (Hymenoptera: Diprionidae). In Neodiprion lecontei and Neodiprion sertifer the acetate of this alcohol is the major component of their sex attractant; in Diprion similis it is the propionate. By examining the responses of the male antennae of several species of Neodiprion through the electroantennographic technique, it was determined that four species responded to the acetate and six to the propionate.


Nonenzymic joining of oligoadenylates on a polyuridylic acid template. 3',5'-Linked hexa-adenylic acid with a 2',3'-cyclic phosphate terminus [(A5A less than p] couples on a polyuridylic acid template in the presence of ethylenediamine to form the dodecamer (24 percent) and octadecamer (5 percent). The bond produced is largely that of the 2',5' isomer.


Insect photoperiodism: the "T experiment" as evidence for an hourglass mechanism. "T experiments" demonstrate that the clock controlling termination of larval diapause in Ostrinia nubilalis is an hourglass mechanism that measures 8 hours of darkness. Circadian oscillations are not involved in photoperiodic time measurement in this species.


Tin: a potent inducer of heme oxygenase in kidney. Tin greatly enhances heme breakdown in kidney, thus impairing heme-dependent cellular functions, such as cytochrome P-450 mediated drug biotransformation. This novel action of the metal results from a potent induction effect on heme oxygenase, the enzyme that catalyzes heme oxidation in microsomes. The possible toxicological implications of this tin effect in the kidney merit further investigation.


Reinvestigation of oak leaf roller sex pheromone components and the hypothesis that they vary with diet. The sex pheromone of the oak leaf roller, Archips semiferanus, was identified as a specific blend (67:33) of trans-11- and cis-11-tetradecenyl acetates. The pheromone blend of females from a semisynthetic diet and from three oak species did not vary significantly. Males from these diets responsded in the laboratory and the field only to treatments approximating the 67 : 33 blend. These findings conflict with the hypothesis that the composition and perception of month sex pheromones vary with slight changes in diet.


Insect phermones: diet related?

Insect phermones: diet related? The question of the origin of insect pheromones is discussed in the light of new published information on the communication system of the oak leaf roller. It is concluded that compounds found in diets may be partially responsible for insect sexual behavior and that substructuring of insect populations in ecological and evolutionary time through dietary chemicals remains a hypothesis worthy of further testing.


Spatial frequency-contingent color aftereffects. Two-dimensional Fourier analysis of checkerboards reveals that major components are at a 45 degree angle to the check edges. After adapting to chromatic checkerboards, subjects who viewed achromatic grating stimuli reported that complementary color aftereffects are aligned with spatial frequency components rather than with the edges in the pattern.


A comparison of Fourier analysis and feature analysis in pattern-specific color aftereffects. Subjects were adapted to alternating upright red and oblique green checkerboards. After adaptation, vertical and horizontal gratings appeared pink and oblique gratings appeared green. The results show an orientation and spatial frequency selectivity predicted by two-dimensional Fourier analysis.


Introversion/extroversion, time stress, and caffeine: effect on verbal performance. Time pressure and caffeine differentially affected the performance of introverts on verbal ability tests similar to the Graduate Record Examination. With time pressure and 200 milligrams of caffeine, the performance of introverts fell by 0.63 standard deviation, but extroverts by 0.44 standard deviation.


Lead poisoning: altered urinary catecholamine metabolites as indicators of intoxication in mice and children. Whether neuropsychological impairment occurs in children with increased lead absorption who are without clinical symptoms is of current concern. This tissue, which involves potentially large numbers of children, remains unresolved, in part because of the lack of sensitive biochemical indicators of the effects of lead on the nervous system. In experimental subclinical lead poisoning in mice, significant increases in homovanillic acid and vanillylmandelic acid have been found in brain and urine. In children with increased lead absorption, these acids were meaured in urine collected quantitatively under controlled dietary conditions; preliminary results show fivefold increases in the daily output of these compounds. These data suggest that the altered catecholamine metabolism also occurs in children.


A novel means for dealing with L-canavanine, a toxic metabolite. L-canavanine is a highly toxic L-arginine analog found in some leguminous seeds. Larvae of the bruchid beetle Caryedes brasiliensis, collected in Costa Rica, subsist solely on tissues of the mature seed of Dioclea megacarpa, which contains more than 8 percent L-canavanine by dry weight. The arginyl-tRNA synthetase of the bruchid beetle larvae discriminates between L-arginine and L-canavanine, and canavanyl proteins are not synthesized. In this way, bruchid beetle larvae avoid an adverse biochemical effect of L-canavanine.


Morphine-induced rotation in naive, nonlesioned rats. In rats injected with morphine in the midbrain reticular formation, pronounced ipsilateral rotation behavior was elicited by mild auditory and visual stimuli. The frequency of occurrence and rate of rotation were dose-dependent. This effect was site specific and drug specific; other drugs (except heroin) failed to induce this behavior. Naloxone potentiated the morphine rotation. Pretreatment with drugs that either potentiated or attenuated the morphine rotation indicated involvement of the noradrenergic and cholinergic systems and excluded a role for the dopaminergic system. No analgesia was observed after morphine microinjection in this site; thus, the hyperresponsivity to mild auditory and visual stimuli and concurrent analgesia previously seen in animals with morphine microinjections in the periaqueductal gray matter appear to be dissociable effects of morphine, and site specific.


Falcon visual acuity.

Falcon visual acuity. Grating acuity, the ability to resolve high-contrast square-wave gratings, was measured in a falcon and in humans under comparable conditions. This behavioral test of falcon acuity supports the common belief that Falconiformès have superb vision-the faclon's threshold was 160 cycles per degree, while the human thresholds were 60 cycles per degree. Falcon acuity, however, was much more dependent on lumanance, declining sharply with decreases in luminance.


Growth promotion by homocysteic acid.

Growth promotion by homocysteic acid. Homocysteic acid, H03SCH2CH2CHNH2CO2H, promotes growth of hypophysectomized rats, assayed by observation of increased thickness of epiphyseal cartilage of the tibia and by observation of tail growth. Doses of homocysteic acid as low as 1 microgram per day for 4 days in the tibia assay and 2.5 milligrams per kilogram per day for 5 weeks in the tail assay were effective in promoting growth. Serum somatomedin activity, determined by the porcine cartilage disk assay, was also increased by homocysteic acid. These findings relate an area of sulfur amino acid metabolism to the physiological action of growth hormone, accelerated growth in homocystinuria, initiation of arteriosclerosis, and control of cellular growth.


Peripheral blood elements found in an Egyptian mummy: a three-dimensional view. Intact peripheral blood elements were found within an intracranial mass, possibly eithern an antemortem subdural hematoma or a postmortem blood clot, removed from a 2200-year-old Egyptian female mummy. Surface topographies of neutrophils and lymphocytes were similar. Some erythrocytes partially retained their biconcave disk shape; others were spherical. Individual platelets exhibited pseudopodia.


Sexual differences in the auditory system of the tree frog Eleutherodactylus coqui. Acoustic playback experiments with calling males in their natural habitat and two-choice orientation experiments with females indicate that males and females of the neotropical tree frog Elutherodactylus coqui respond to different notes in the two-note call of the male. This functional dichotomy of the two notes in the male's call reflects a difference in the distribution of the best excitatory frequencies of primary auditory neurons for the males and females. To the best of our knowledge, Eleutherodactylus is the first known example of a vertebrate in which the peripheral auditory sensitivity shows a sexual difference.


Incentive contrast in honey bees.

Incentive contrast in honey bees. Bees trained to come to the laboratory for a 20% sucrose solution accept it readily, but bees trained with a 40% sucrose solution and tested with the 20% solution show a pattern of interrupted feeding that may last for several minutes. Bees trained with 20% and tested with 40% sucrose are undisturbed. When the animals are offered two samples of the 20% solution simultaneously, they drink to repletion from whichever they first taste on each visit, but if both a 20% and a 40% drop are offered the 20% solution is rejected after a single experience of the 40% solution. Although these results are analogous in many respects to incentive contrast effects found in mammals, they can be understood in sensory terms and do not require the assumption of learning about reward.


Hyperphagia and increased growth in rats after intraventricular injection of 5,7-dihydroxytryptamine. Juvenile male rats given intracerebroventricular injections of 5,7-dihydroxytryptamine, following treatment with desmethylimipramine, maintained body weight gains of 5 to 6 grams per day into adulthood and grew much larger than control rats. Biochemical analyses of brain tissue obtained 50 to 140 days after the injections revealed 60 to 86% depletions of telencephalic 5-hydroxytryptamine, with catecholamine levels unchanged. Hyperphagia did not develop despite comparable losses of 5-hydroxytryptamine when the pretreatment was withheld, perhaps because substantial depletions of norepinephrine occurred as well.


The "pincushion grid" illusion.

The "pincushion grid" illusion. The illusion generated by a "pincushion grid" is not predicted from the two-dimensional Fourier transform of the grid. This implies that the visual system may not perform two-dimensional Fourier transforms of observed patterns.


Eyeblink inhibition by monaural and binaural stimulation: one ear is better than two. Airpuff-elicited eyeblink, like many other reflexes, may be inhibited when an auditory stimulus precedes the reflex-eliciting stimulus by approximately 100 milliseconds. This inhibition is greater when the auditory stimulus is delivered to one ear than when it is presented binaurally.


d-Amphetamine-induced inhibition of central dopaminergic neurons: mediation by a striato-nigral feedback pathway. Lesions of the striato-nigral pathways (that is, crus cerebri or vicinity of the tail of the caudate nucleus) markedly attenuate depressant effects of intravenous d-amphetamine on central dopaminergic cell activity. These results, coupled with previous data showing that microiontophoretic application of d-amphetamine directly onto dopaminergic cells does not produce significant slowing, provide direct support for the hypothesis that the depressant effect of d-amphetamine on these cells is mediated through a striato-nigral neuronal feedback loop.


Stable and plastic unit discharge patterns during behavioral generalization. A movable microelectrode was implanted in adult cats trained to respond differentially to two different frequencies of light flicker. Unit responses were recorded along cortical and thalamic trajectories. The late components of the poststimulus response of 29% of the cells examined showed statistically significant differences when data from different behavioral outcomes to the same neutral generalization stimulus were compared.


Differing attenuation coefficients of normal and infarcted myocardium. There are significant differences in attenuation coefficients between normal and infarcted myocardium measurable with a computerized transaxial tomographic scanner. Additionally, iodinated contrast material administered prior to killing the tests animals resulted in excellent visualization of the blood-myocardial interface at a time when standard radiographs detected no differences between the ventricular cavity and the myocardial wall. These natural and induced changes in attenuation coefficients offer a new approach to evaluating and understanding the processes of tissue injury and death. Their clinical relevance lies in application to the twin problems of myocardial infarction and the structure and function of the cardiac wall.


Phosphorylated sites in substrates of intracellular protein kinases: a common feature in amino acid sequences. Examination of the primary amino acid sequences surrounding phosphorylated sites in many intracellular phosphoproteins indicated that the phosphorylated hydroxyamino acid (either serine or threonine) is, in general, surrounded by amino acids having a positively charged side chain and, more specifically, is frequently separated from a basic amino acid (either lysine or arginine) by only one amino acid. Possible reasons for this common feature are discussed.


Dendritic reorganization of an identified motoneuron during metamorphosis of the tobacco hornworm moth. In the tobacco hornworm, many larval motoneurons become respecified and supply new muscles in the adult. Changes in the morphology of one such neuron were examined through metamorphosis. The dendritic pattern of the adult comes about both by outgrowth from the primary and secondary branches of the larval neuron and by the development of new branches that are unique to the adult.


Neuronal substrate of classical conditioning in the hippocampus. Neuronal activity in dorsal hippocampus was recorded in rabbits-during classical conditioning of nictitating membrane response, with tone as conditioned stimulus and corneal air puff as unconditioned stimulus. Unit activity in hippocampus rapidly forms a temporal neuronal "model" of the behavioral response early in training. This hippocampal response does not develop in control animals given unpaired stimuli.


Rapid discrimination of rewarding nutrient by the upper gastrointestinal tract. When certain nutrients are injected into the stomachs of rats that are drinking one of two samples of nonnutrient, flavored water, the rats will (within a 10-minute session) choose the flavor paired with the nutrient. Such rewarding effects have obtained with predigested milk but not with similarly treated glucose or fresh milk. The results suggest the presence of rapidly acting, specialized, nutrient receptors in the upper gastrointestinal tract.


Lens culinaris lectin immobilized on sepharose: binding and sugar-specific release of intact tissue culture cells. Lens culinaris lectin (LCL) covalently linked to 2B Sepharose binds tissue culture cells to the matrix. This is prevented by hapten sugars specific for LCL. Unlike other immobilized lectins, lens culinaris lectin allows the removal of bound cells from the matrix on addition of the specific sugars in a concentration-dependent manner. Binding and release occur under physiological conditions. Released cells continue to grow.


Facial muscle patterning to affective imagery in depressed and nondepressed subjects. When subjects imagine happy, sad, and angry situations, different patterns of facial muscle activity are produced which can be measured by electromyography. These subtle, typically covert, facial expression patterns differentiate depressed from nondepressed subjects. Facial electromyography can provide a sensitive, objective index of normal and clinical mood states.


Evolution of genome size by DNA doublings. Logarithmic distributions of nucleic acid contents per genome of species within major phylogenetic groups of organisms tend to form several peaks. These peaks appear to represent intragroup doublings of DNA or RNA which, in the case of eukaryotes, are independent of polyploidy. This phenomenon has been termed cryptopolyploidy. There are numerical similarities in peak values for different taxonomic groups. A high degree of order is suggested when minimum values for the major phylogenetic groups are plotted against a series of theoretical doublings. These data demonstrate the apparent existence of an exponential periodicity over eight orders of magnitude, leading us to suggest an evolutionary continuity of doublings of a basic ancestral genome (of about 300 nucleotides), these doublings being independent of both chromosome number and ploidy level. This proposed continuity encompasses most major life forms and is generally concomitant with increasing evolutionary complexity, particularly in the prokaryotes and lower eukaryotes. Our interpretation of the data presented here must currently be viewed as speculative, and we do not propose that genome doubling is the only mechanism for genome evolution. However, we feel that the evidence is sufficient to warrant serious scrutiny of our proposals. We hope that this approach to a synthesis of available data will provoke discussion and will stimulate further work toward either supporting, modifying, or disproving our hypothesis.


Binocular vision: two possible central interactions between signals from two eyes. Both foveae of light-adapted subjects were stimulated at the same time with monocularly presented lights of increasing or decreasing luminance. Combinations judged just detectable violated predictions of the energy summation and the probability summation hypotheses of binocular interaction. Rather, the results can be explained by independent central neural mechanisms that signal the sum or the difference of stimuli to two eyes.


Complement-dependent immunoglobulin G receptor function in lymphoid cells. Lymphoid cells are unable to lyse antibody-coated target cells in the presence of normal immunoglobulin G (IgG), presumably because their surface receptors of IgG are blocked. However, when target cells are sensitized with antibodies and complement, IgG receptors are unblocked and cytotoxicity occurs even in the presence of normal IgG. Thus, IgG receptors may function in vivo despite the relatively high concentations of IgG in serum and interstitial fluid.


Antiserum to somatostatin prevents stress-induced inhibition of growth hormone secretion in the rat. Plasma growth hormone levels fall and remain low for several hours after stress in the rat. When antiserums to somatostatin are administered to rats prior to stress, growth hormone secretory pulses are partially restored. The results provide evidence that circulating somatostatin plays a prominent role in stress-induced inhibition of growth hormone secretion in the rat.


Sibling species in the marine pollution indicator Capitella (polychaeta). Electrophoretic patterns for eight enzyme loci clearly distinguish six sibling species in the well-known pollution indicator worm, Capitella capitata. Unlike sibling species of Drosophila, the Capitella species have virtually no alleles in common. Close examination has revealed only slight morphological differences between species, while life histories and reproductive modes are very distinct. The Capitella species are ideally suited for genetic and evolutionary studies.


Sex differences in cognition: a function of maturation rate? Regardless of sex, early maturing adolescents performed better on tests of verbal than spatial abilities, the late maturing ones showed the opposite pattern. Those maturing late were more lateralized for speech than those maturing early. Sex differences in mental abilities, it is argued, reflect differences in the organization of cortical function that are related to differential rates of physical maturation.


Management of breast cancer: past, present, future. The historical management of breast cancer leading up to the Halsted era is reviewed. Radical mastectomy is examined and evaluated in the light of cancer staging, and different modes of treatment are discussed. The question of what type of surgery and adjuvant therapy is best for each patient is not fully answered and awaits further study and clinical trials. The future promises an immunobiologic approach in the treatment of breast cancer in addition to early operation.


The breast cancer conundrum.

The breast cancer conundrum. The rate of survival for patients with breast cancer is determined by the interaction of the tumor spread and the tissue ablated by the method. Clinical estimates of tumor spread are grossly inaccurate. Therefore the rate of survival is an unreliable index of the quality of the method, and a comparison of survival rates is not likely to reveal which method is superior. Nevertheless, the cancer arises in the breast, spreads away from the breast, cannot be accurately staged, and must be totally eradicated for the achievement of cure. The principle of treatment is therefore the ablation of the primary tumor and the largest amount of adjacent expendable tissue at the earliest time. Compliance of the method with this principle will produce the best possible result. Superior therapy is evidenced by compliance of the method with the principle of treatment rather than by a comparison of the rates of survival.


Cholesterol crystal microembolization: a cause of the restless leg syndrome. The restless leg syndrome is characterized by unpleasant lower extremity nocturnal aching, muscle cramps, and restless shuffling. Although the cause remains unknown in the majority of cases, two instances are reported of the restless leg syndrome caused by peripheral cholesterol crystal microemboli. The syndrome caused by cholesterol microemboli and the syndromes of the restless leg are reviewed.


Retrospective critical review and analysis of bilateral staged pulmonary resections for treatment of pulmonary tuberculosis. A critical retrospective analysis of 14 cases of bilateral staged pulmonary resections for the treatment of pulmonary tuberculosis is described. Lobectomies with or without segmentectomies were the preferred procedures. The four positive cases had mostly cavitary disease (85%) with positive bacteriologic culture from the specimens (75%). The ten negative cases had less cavitary disease (65%) with negative bacteriologic culture of the specimens (90%). Positive residual bacteriologic specimen activity (10%) of the negative group favors the surgical removal of residual disease, despite the fact that 45% have no culture or bacterial stain obtained. Negative residual bacteriologic specimen activity (25%) of the positive group indicates the limitations of inadequate surgery. Thus the indications of surgery may gradually reestablish their own crieteria in this era of massive chemotherapy.


An analysis of practice in Georgia and South Dakota. Family practitioners in Georgia and South Dakota were surveyed in order to ascertain percentage of practice devoted to various specialty areas, daily case loads, type of diagnoses, method of handling telephone calls, and patterns of agency utilization. Questionnaires were sent to all South Dakota and Georgia family practitioners. In Georgia 22% of family practitioners do no surgery and 55% do no obstetrics, while in South Dakota 90% practice obstetrics. Differences in availability of specialists and in pysician referral patterns caused marked variations in family practice patterns. Diagnoses showing geographic differences included chronic lung disease, arthritis, sore throat, heart disease, and neuroses. About 50% of all physicians handled medical phone calls personally. Less than half the respondents in each state used some agency or resource in this time period. The distribution of specialists affects the patient load and needs to be considered when primary care is planned.


Alveolar soft part sarcoma.

Alveolar soft part sarcoma. Alveolar soft part sarcoma is a rare, highly malignant tumor. It usually arises in the skeletal muscles in the extremities of patients in their second or third decade with a female preponderance of 2:1. Three additional cases, including the angiographic findings, have been presented. The literature pertaining to this subject also has been reviewed.


Blood trace metals in military recruits. Whole blood samples obtained from 2,000 military recruits were analyzed for cadmium, copper, lead, and zinc by atomic absorption spectroscopy. Whole blood copper levels were symmetrically distributed and those for cadmium, lead, and zinc were positively skewed. Average whole blood levels for copper and zinc were generally comparable to published values, but cadmium and lead values were somewhat higher, suggesting possible absorption of trace metals from containers during storage. Average cadmium and zinc levels were similar among blacks and whites, whereas average copper and lead levels were significantly higher in blacks. Cigarette smokers had higher copper levels than nonsmokers. Cadmium and zinc whole blood levels varied inversely with educational attainment. Copper, lead, and zinc levels varied by place of residence, suggesting the influence of dietary or other factors. Future studies characterizing trace metal body burdens or relating trace metals to diseases must carefully measure such pertinent attributes as age, sex, race or ethnic group, smoking habits, diet, and environmental exposure.


Isoniazid-induced convulsions.

Isoniazid-induced convulsions. Acute isoniazid overdose and toxicity may be complicated by convulsions and death. Six patients are reported, one of whom ingested simultaneously 15 gm of isoniazid and 5 gm of pyridoxine hydrochloride (vitamin B6); no convulsions resulted. In the light of this and other experience, suggestions are made for the use of pyridoxine in the treatment and prevention of acute isoniazid poisoning.


Multiple myeloma in Oklahoma: racial, age, sex, geographic and time variations. Oklahoma death certificates listing multiple myeloma as the underlying cause of death during the period 1950-1970 were examined for secular trends, and geographic and demographic characteristics associated with the disease. An upward trend in the death rates for all age, sex and race groups was found; the most dramatic increases were seen in the oldest age groups. During the 20-year period, the death rate for white males 75 years of age and older increased tenfold. For white females 75 years of age and older. It increased eightfold. White male rates were constantly higher and showed a sharper increase in age-adjusted death rates than white female rates. Because of the low number of nonwhite deaths in Oklahoma from multiple myeloma, the rates showed extreme fluctuations. After adjustments were made for age differences, the nonwhite annual rate was 2.36 per 100,000 compared with 1.62 for the white population. There was not enough information to draw conclusions about the geographic distribution of multiple myeloma. Findings for the Oklahoma population were consistent with the few previously reported studies.


A new instrument for uncomplicated emergency cricothyrotomy. A new device for establishing an emergency airway provides sterility, anesthesia, control of bleeding, safe and quick entrance into the cricothyroid space, and adequate air exchange. In addition, the device is compatible with standard anesthetic and resuscitation machines, inexpensive, and small enough to be carried in a pocket.


Sudden unexplained death in a psychiatric patient taking thioridazine. This report describes the sudden unexplained death of a young, physically healthy, psychotic woman. She had received moderate doses of thioridazine for four days prior to her death. No cause of death could be determined at autopsy. The literature regarding other such case reports and possible cardiotoxic effects of phenothiazine is cited, but no clear-cut correlations or explanations have been demonstrated.


Epidemiologic aspects of nosocomial infections. In a currently ongoing surveillance of hospital-associated infections in two metropolitan hospitals in Oklahoma, the results over a four-month period suggest at least tentative principles of host-agent relationships in hospital-associated infections. Within the urinary tract, the site with the highest number of total isolations, Escherichia coli and Klebsiella pneumoniae were the most common pathogens. By age, the under 5 and over 60 year age groups had the highest number of isolations. Staphylococcus aureus and E coli were isolated more frequently in the younger group, while K pneumoniae, Serratia marcescens, and Proteus mirabilis occurred more frequently in infections among the older group. A higher frequency of Enterobacter sp and S aureus were isolated among male patients, while Candida  albicans and E coli apparently had a greater affinity for females; however, none of these differences by sex were statistically significant. Over 50% of the infections were manifest within the first ten days of hospitalization.


Cast bracing for femoral shaft fractures. The femoral cast-brace offers a new method of treatment for femoral shaft fractures. The cast-brace is especially well suited to fractures below the isthmus, although it can be used to treat those more proximal by giving special attention to detail. The method allows early knee motion without prolonged bed rest. Patients who should not be operated on for any medical reason or whose fracture is not amenable to surgery may be treated with the cast-brace. A series of patients with simple and complicated problems that have been treated with the cast-brace is presented. Comparisons between femoral cast-bracing, intramedullary nailing, and traction treatment are made.


Barrett's esophagus: a multifaceted condition. Five patients with Barrett's esophagus, each with a differing presentation, serve as the basis of this report. Hiatal hernia is noted to be frequently present in Barrett's esophagus, and the incidence of adenocarcinoma is thought to be distinctly increased. The condition is easily diagnosed by fiberoptic endoscopy and verified by direct biopsy. The increasing use of fiberoptic panendoscopy may lead to an increased frequency of diagnosis of the columnar cell-lined lower esophagus and its complications.


Staphylococcal septicemia: successful treatment of complications in a child. A previously healthy 5-year-old girl developed staphylococcal septicemia. Initially, cardiovascular failure with mitral insufficiency and purulent pericarditis dominated the clinical picture. Peripheral thromboembolic phenomena, meningitis, osteomyelitis, and persistent septicemia were subsequently encountered during antimicrobial and surgical therapy. Although staphylococcal septicemia is a potentially lethal disorder, anticipation of its natural course and its possible complications should lead to more successful management.


Arteriomesenteric duodenal compression syndrome: comparison of methods of treatment. A group of 80 patients with arteriomesenteric duodenal compression syndrome was reviewed, 48 from the general population and 32 from the Hines, Illinois, VA Hospital. Differences in the patient populations are pointed out, as are differences in the therapeutic results. An additional series is reported. Duodenojejunostomy is a safe and effective operation for the majority of patients who require surgery for this condition, and patients are less likely to require further medical or surgical care than those who have section of the ligament of Treitz.


Clindamycin-associated pseudomembranous colitis treated with prednisone. A patient with clindamycin-associated pseudomembranous colitis is presented. His dramatic response to prednisone suggested an immunologic basis of the disease process. This aspect of etiology and therapy has not been emphasized previously. Similar patients with clindamycin-associated pseudomembranous colitis should be sought out and consideration should be given to this type of treatment.


The unexpected pheochromocytoma.

The unexpected pheochromocytoma. We have presented the case history of a patient with unilateral pyelonephritis and elevated peripheral venous renin, an obvious cause of renal hypertension. However, a complete evaluation revealed pheochromocytoma as the primary cause of the hypertension. It is assumed that the increase in renin is secondary to catecholamine stimulation. Since surgery or diagnostic procedures may be disastrous in a patient with unsuspected pheochromocytoma, we urge all physicians to make a special effort to detect the presence of a tumor in the hypertensive patient.


Liver hernia diagnosed by liver scan and confirmed by angiography. A right-sided diaphragmatic hernia contining a portion of liver is presented. The diagnosis was made by liver scan and confirmed by selective angiography. The clinical and radiologic findings are discussed. The arteriogram of the herniated liver is the first angiographic demonstration of this entity.


Pharmacological prophylaxis of venous thrombo-embolism. The pathogenesis of venous thrombosis is briefly discussed as a basis for the understanding of preventive measures used in this condition. Prophylaxis in venous thrombosis is then reviewed with emphasis on pharmacological treatment, and more particularly on heparin.


Portal vein thrombosis with ascites. A case report. A case of portal vein thrombosis with ascites in an adult is presented with postmortem findings. The experience at Groote Schuur Hospital of portal vein thrombosis and Budd-Chiari syndrome between 1964 and 1974 is summarised and the literature is reviewed.


A full-term fetus with holo-acranial anencephaly and other abnormalities. A fetus with no head or neck was dissected in order to trace possible remnants of those structures. Many other abnormalities were also displayed. Mechanisms of anencephaly are discussed, especially those which probably caused this malformation.


Polyostotic fibrous dysplasia with acromegaly (Albright's syndrome). A case report. The association of polyostotic fibrous dysplasia and acromegaly, presenting with gross deformity of the skull and fractures of the left femur and right humerus, is described in a 42-year-old Black woman. Possible causative factors are discussed.


The blocking by autologous serum of maternal cell-mediated immune reactions to placental antigen. The reactivity of splenic lymphocytes to a placental antigen was assessed in pregnant and control rats by means of a macrophage migration inhibition test. The pregnant but not the control animals, showed increasing cell-mediated immunity, which persisted until the second week after parturition. Migration inhibition could be abolished when sensitised lymphocytes were first pulsed with serum from the pregnant animal in the presence of antigen. This blocking effect was obtained only with autologous but not with normal or heterologous pregnant rat serum, and did not occur when antigen was omitted from the pulse. The results indicate that pregnant animals have cell-mediated immunity against a placental antigen, but the serum of these animals has a central enhancing effect which is antigen-dependent.


Aspects of radiofolate absorption, metabolism and plasma binding. After 14C-methyl folate (14C-MeTHF) was taken by mouth, progressive incorporation of this istope into the dialysis-resistant plasma folate fraction occurred. At 6 hours 68,9% of the total plasma radioactive folate was dialysis-resistant. We have previously shown that 14C-folic acid (14C-PGA) taken by mouth is not similarly bound at 6 hours. Chromatography of plasma on DEA A50 after 14C-PGA absorption, showed that PGA in plasma (peak 1) was gradually converted to MeTHF (peak 2) and the absence of bound radiofolate 6 hours after 14C-PGA ingestion probably reflects this conversion phase. No radiofolate appeared in red cells up to 11 days after isotope ingestion. Initial divergence between plasma biofolate and radiofolate indicated that 'cold' storage folate was being displaced by abosrbed radiofolate. Urinary radiofolate resolved into 3 fractions (peaks 2, 3 and4) on DEAE A50 chromatography. One of these (peak 2) corresponded to MeTHF, but PGA (peak 1) was absent. Plasma showed peaks 1, 2 and 3, but at 3 hours no equivalent of urinary peak 4 was evident. Further studies are indicated to characterise fractions 3 and 4.


Some clinical problems in patients undergoing thrombolytic therapy. A total of 25 patients (7 with arterial occlusion and 18 with venous thrombosis) were treated with streptokinase for 72 hours, followed by heparin for 24 hours. The clinical problems, complications and results obtained are discussed. Within the limits imposed by the study, it is concluded that streptokinase offers safe and effective therapy for early iliofemoral venous thrombosis.


The need for objective diagnosis of deep vein thrombosis. In a series of 81 limbs in which the clinical diagnosis of deep vein thrombosis was suspected, objective confirmation could be obtained in only 24 or 30%. Of the patients who presented with signs and symptoms of deep vein thrombosis confined to the calf, the diagnosis was confirmed in only 37%. In view of the attendant morbidity and mortality associated with anticoagulation therapy, it is suggested that in all patients in whom the clinical diagnosis of deep vein thrombosis is made, objective confirmation should be obtained by one or more of the currently available methods, before the initiation of long-term anticoagulation therapy.


The successful treatment of creeping eruption with topical thiabendazole. Fifty patients with creeping eruption were treated topically with an aqueous suspension of 15% thiabendazole. A permanent cure was obtained in 94% of patients within a fortnight and in 98% within 3 weeks. No significant side-effects were encountered and at present topical thiabendazole is the treatment of choice for this condition.


Difficult reduction of traumatic dislocation of the hip. A case report. Difficulties in the reduction of a traumatic posterior dislocation of the hip, as a result of soft-tissue interposition, are uncommon. A case in which closed reduction was prevented by a partly detached labrum acetabulare is reported.


Crystalloid versus colloid hemodilution in man. The effects of intraoperative prebleeding and hemodilution with lactated Ringer's solution on hemodynamics, oxygen transport and lung water were studied in four patients undergoing extensive surgical procedures. The results were contrasted with those previously obtained from hemodilution of a group of patients with Plasmanate. The mean volumes bled were 1,950 milliliters in the lactated Ringer's solution group and 1,697 milliliters in the Plasmanate group. The posthemodilution hematocrit values were 26 per cent and 25 per cent, respectively. Cardiac output increased to only 115 per cent of the base line in the lactated Ringer's solution group but to 161 per cent in the Plasmanate group. Systemic oxygen transport was reduced to 80.0 per cent in the lactated Ringer's solution group, while in the Plasmanate group, it rose to 109.7 per cent. The lung water and alveolar arterial oxygen gradients were increased to 134 and 112 per cent in the lactated Ringer's solution group, whereas in the Plasmanate group, the lung water was reduced to 82 per cent, and the arterial alveolar oxygen gradient was reduced to 75 per cent. In these selected patients, hemodilution was well tolerated. Plasmanate hemodilution resulted in better compensatory changes than did hemodilution with lactated Ringer's solution in terms of oxygen transport and changes in lung water.


An analytic critique of existing classification systems for cancer of the breast. The most popular systems of histologic typing for cancer of the breast have been analyzed as far as details of construction and results of application. The constituents of all systems are debatable. Lack of uniformity and standardization is obvious, while meaningful comparisons in terms of results and prognostic evaluation are unfeasible. Although the attempts to classify histologic patterns are hampered by the observers' variability and by the existence of different patterns within the same tumor, efforts have to be made to further standardize the terms used for designating histologic types. Additional aid can be expected from histologic grading and morphologic host defense reaction evaluation to substantiate the prognostic evaluation of individual cancers of the breast.


Regional antibiotic infusion of the heart. Regional arterial infusion of the heart and lung with an antibiotic did not increase the drug in the aortic serum to concentrations that would be clinically significant when compared with concentrations which can be attained by the intravenous method in a near normal functioning heart.


Therapeutic value of nafoxidine hydrochloride in the treatment of advanced carcinoma of the human breast. Nafoxidine hydrochloride can provide additional palliation to patients who responded to previous endocrine ablation and had tumors containing an estrogen receptor. In the present study, 24 patients were evaluated for their response to nafoxidine therapy, 180 to 240 milligrams given orally per day. When tumor response was obtained, doses were reduced to 60 to 120 milligrams every other day or longer without loss of control. In the estrogen receptor positive group, eight of ten patients responded objectively to nafoxidine, while all seven estrogen receptor negative patients progressed with this therapy. These results demonstrated that nafoxidine is effective in the treatment of estrogen receptor positive cutaneous disease. These results demonstrated that nafoxidine is effective in the treatment of estrogen receptor positive cutaneous disease. Patients with lesions to other sites should receive cytoxic agents along with nafoxidine. Alternative therapy to nafoxidine should be considered for patients in whom the tumors contain negligible estrogen receptor.


Evaluation of pulmonary function in the ischemic expanded canine lung. Twenty-four dogs underwent in vivo left pulmonary hilar occlusion with the lung continuously expanded at 10 centimeters or 25 centimeters of water pressure to determine the period of pulmonary ischemia that may be tolerated before consistent pulmonary edema and congestion develop after lung revascularization. Consistent and prolonged pulmonary edema and congestion that caused death of the dog occurred in at least one-half of the dogs  when the period of hilar occlusion was extended beyond six hours. Elevation of the left pulmonary artery pressure was only a rough measurement of the severity of the anoxic pulmonary injury. Expansion of the lung at 10 centimeters of water continuous pressure was more beneficial than was expansion at 25 centimeters of pressure. Cyclic ventilation with slight negative-expiratory pressure provided less support to the lung than did continuous expansion at either pressure tested. Intial decreases in both ventilation and perfusion isotope uptake and the percentage of the total volume of oxygen uptake per minute by the ischemic lung returned to near normal levels in three weeks in dogs that survived. Lung expansion during periods of ischemia appears to prevent alveolar collapse and to facilitate oxygenation.


A simplified, improved techniqe for the Collis gastroplasty for dilatable esophageal strictures. A safe, simple, effective and fast gastrophasty for the dilatable strictured esophagus has proved sound in dogs and feasible and effective in twenty-five patients. Several of the patients who had been operated upon elsewhere had recurrences. Postoperative follow-up studies of the 25 patients operated upon have revealed freedom from substernal pain, dysphagia, aspiration and bleeding in the upper part of the gastrointestinal tract. Encouraged by the success of the surgical techinique in patients with stricture of the esophagus, we have recently applied the same technique in the repair of hiatal hernia without stricture.


Simulated acute appendicitis secondary to ventriculoperitoneal shunt. A case of simulated acute appendicitis caused by a ventriculoperitoneal shunt is described. This case presented as a perplexing clinical problem. When the diagnosis was established by laparotomy, it was apparent that another complication should be added to the list of abdominal complications which occurred secondary to insertion of a ventriculoperitoneal shunt.


Hydrocephalus: I. Histological and ultrastructural changes in the pre-shunted cortical mantle. Hydrocephalus results in a reduction in the thickness of the cerebral cortical mantle which seemingly is restored by ventricular shunting. In order to determine the effect of hydrocephalus and its potential reversibility, experimental hydrocephalus was produced in adult cats by the introduction of kaolin or silicone into the basal cisterns followed by bilateral craniectomies. Microscopic and fine structural studies of these animals suggest the occurrence of significant focal axonal destruction. These studies suggest a sequence of events consisting of ventriculomegaly, disruption of the periventricular ependyma, periventricular edema, axonal destruction, secondary myelin disintegration and finally reactive astrocytosis. The damage to axons and meylin and resulting gliosis is irreversible.


Hydrocephalus: II. Cell number and size, and myelin content of the pre-shunted cerebral cortical mantle. The number of cells in the brain and their size can be calculated by determining the total brain DNA, RNA and protein. Myelin can be determined biochemically. This analysis was applied to brains of a group of adult cats with craniectomies that were made severely hydrocephalilc by the introduction of kaolin or silicone into the basal cisterns. In severely hydrocephalic brains sectioned rostral to the area of kaolin inflammation there was no loss of dry weight. Wet weight increased slightly reflecting periventricular edema. There was a slight increase in total DNA, RNA and protein, presumably reflecting the increase in small inflammatory cells. There was a significant reduction in galactolipids reflecting myelin loss.


Frontal extradural hematomas.

Frontal extradural hematomas. In a series of 1841 severe head injuries, 97 cases of epidural hematomas were observed. Among these there were 13 in the frontal area, i.e. 13.4%. The nine cases of frontal extradural hematomas not previously reported are described. Five of them had "pure" extradural frontal clots. In four cases the epidural hematoma was associated with intradural lesions. The "pure" frontal epidural cases presented a subacute to chronic course of a benign character. All of these patients survived and made a complete recovery after operation. A malignant, stormy and fatal course was observed in the "mixed" cases.


Arteriovenous malformations of the anterior and the middle portions of the corpus callosum: microsurgical treatment. The arterio-venous malformations of the corpus callosum are distinct clinical and surgical entities. Review of literature reveals 45 documented cases of which 32 were treated surgically. The authors (M.G.Y.) had 18 such patients of which eight involved the anterior and the middle portions of the corpus callosum. (No. 8 involved the whole callosum). The patients were in the younger age group. Headache and stiffness of the neck were the common presenting features. Seizures were rare and there was a paucity of localizing neurological signs. These AVMs are supplied mainly by the pericallosal arteries and occasionally by branches of the posterior cerebral artery. The drainage is by septal veins, the inferior sagittal sinus and the superior sagittal sinus. Radical excision of these AVMs in the anterior and the middle portions of the corpus callosum was accomplished without operative mortality and with minimal morbidity. Radical removal of these anomalies with microsurgical techniques is the treatment of choice.


The anterior cerebral artery: I. Anatomo-radiological study of its cortical territories. A comparative study and angiographic analysis of 24 brains were performed using selective radiopaque injections of the anterior cerebral artery. The arterial branches were projected on a model brain, using a bicommissural system of coordinates and a stereotaxic method as an encephalometric system of reference. Eleven constant cortical branches of the artery were demonstrated and their vascular territories demarcated.


Brain necrosis after repeated radiotherapy. A case of radionecrosis in the brain simulating a tumor was presented. Two courses of radiotherapy were given to a right intraorbital tumor over an interval of ten years. Four years after the second course of therapy, symptoms simulating a right frontal lobe tumor developed. A frontal lobectomy including the necrotic area improved the patient's condition.


Super-selective arteriography of branches of the external carotid artery. Superselective arteriography of the branches of the external carotid artery is of great value in the diagnosis of vascular lesions in the distribution of this artery. These include vascular anomalies of the scalp, the tongue, the ears, the face, the dura mater, and intracranial sinuses, of meningiomas, glomus tumors, angiofibromas of the nasopharynx, and metastases. Super-selective catheterization of the branch of the external carotid artery can also be utilized for the treatment of these lesions by embolization. The technique is described and the various lesions illustrated.


Reversal of aphasia with superficial temporal artery to middle cerebral artery anastomosis. Two patients with aphasia which markedly regressed following superficial temporal to middle cerebral artery anastomoses are reported. Added to the armamentarium of stroke therapy for the amelioration of focal ischemic disease, modern microvascular techniques allow the establishment of collaterals to recipient vessels of less than 1 mm in diameter. A neurological deficit which is supposed to be permanent is usually considered a contraindication to these procedures. This report details two cases in which aphasia and motor weakness markedly improved following a superficial temporal artery to middle cerebral artery anastomosis.


Timing of pentobarbital administration for brain protection in experimental stroke. Significant reduction of experimentally induced cerebral infarction was associated in the canine model with the administration of pentobarbital at one hour postocclusion but not thereafter.


Intracranial pressure gradients in a patient with a thalamic tumor. The clinical history and intracranial pressure records of a patient with a thalamic tumor obstructing the ventricular system is presented. There were sustained differences in pressure between the anterior and posterior parts of the obstructed lateral ventricle. Brain compliance was markedly reduced and there were numerous pressure waves. It is believed that these supratentorial pressure gradients are most marked when there is a loss of brain compliance, and that they contribute to the mechanisms of brain shifts and spreading edema. Thus, they must be taken into account in the management of patients with intracranial mass lesions.


Extradural extrusion of roots of the cauda equina. For lumbar spondylotic stenosis causing progressive disability, multiple laminectomy was about to be completed. Suddenly roots of the cauda equina herniated through the myelography puncture site in the dura mater, resembling redundant nerve roots. This case is being reported not only because such sudden extradural extrusion is rare, but also to raise the question of the relationship of redundancy of nerve roots to spondylotic stenosis.


Epidermoid cyst of the third ventricle.

Epidermoid cyst of the third ventricle. The authors report a case of a cystic epidermoid of the third ventricle in a young female presenting with headache and mental disturbances. The cyst filled completely with gas during ventriculography and was subtotally removed through an interhemispheric callosal-splitting approach.


The edema of cerebral contusion.

The edema of cerebral contusion. A model is described for study of the cerebral edema associated with the contusion of closed head injury. A Remington Humane Stunner was used to deliver blows to the skulls of anesthetized cats. Forty-eight hours after impact, those cats demonstrating a one-sided contusion were tested for cerebral edema by measurement of the decrease in density (specific gravity) of white matter from normal values. Significant change in tissue density was seen in the white matter of contused hemispheres. Hemispheres with contusion limited to the cortex (gray matter) showed a change in tissue density which was considerably less than that seen in hemispheres with contusion involving both gray and white matter.


Acute hemorrhagic cerebellar infarction following angiography. Cerebellar infarction following cerebral angiography is an unusual complication. A case is reported. The patient's condition deteriorated with each diagnostic study. Improvement occurred after cerebellar decompression and evacuation of an intracerebellar hematoma.


Hydrocephalus: III. Reconstitution of the cerebral cortical mantle following ventricular shunting. Adult cats with hydrocephalus were sacrificed at varying times following valveless ventricular shunting. This shunting resulted in a prompt reduction of ventricular size and rapid gross reconstitution of cortical mantle. Ultrastructurally it was evident that white matter edema persisted for many weeks, even in the presence of normal size ventricles. The areas most severely affected by the hydrocephalus such as the corpus callosum showed a paucity of myelinated fibers and their replacement by numerous reactive astrocytes. Reconstitution of the cortical mantle consists predominantly of a diminution of white matter edema and reactive astrocytosis. Clinical improvement undoubtly results from the functional improvement of remaining elements rather than from the replacement of lost elements. This scheme of hydrocephalus suggests that if hydrocephalus is relieved when only ependymal disruption and periventricular water accumulation have occurred, it may be reversible. The subsequent sequence of events consisting of axonal degeneration, myelin disruption and reactive astrocytosis may be less, if at all reversible.


The physics of the cranial cavity, hydrocephalus and normal pressure hydrocephalus: mechanical interpretation and mathematical model. It is intended for this research, to provide some basis for the understanding of the rational mechanics of the cranial content. There are many interesting and controversial facts derived from the experimental and clinical-pathological observations of hydrocephalus and increased intracranial pressure. For instance, in some patients a moderate increase of intracranial pressure is accompanied by hydrocephalus and mental changes, while in others, with high intracranial pressure, the ventricles and mental functions remain unaltered. What then is the parameter that changes the size of the ventricles and impairs brain function? It is shown how the transmission of intraventricular pressure throughout the brain parenchyma creates a stress distribution that varies in magnitude; how during the production, maintenance, and reversal of hydrocephalus, and normal pressure hydrocephalus the stress is distributed throughout the brain; and how in the presence of a sudden increase of intracranial pressure nature has arranged additional mechanisms for protecting the brain. It is important to recognize that some aspects of intracranial physiopathology can be explained through classical concepts of physics, prior to attempting to interpret such processes solely in terms of biological or auto-regulatory phenomena.


Arterial plasma amino acids in patients with serious postoperative infection and in patients with major fractures. Arterial plasma amino acids were measured in 27 patients with serious septic complications after operation, 15 patients following reduction of femoral shaft fractures and nine control patients on the first and third days following uneventful major abdominal surgery. Amino acid concentrations in the controls were similar to those which have been reported during early starvation. The amino acid patterns seen in all groups did not resemble that previously observed following glucocorticoid administration. In the patients with infection, mean phenylalanine concentration (108.0 +/- 46.9 mumoles per liter) was significantly greater than in the controls on the first (p greater than 0.001) or third (p less than 0.001) postoperative days. Four of the septic patients with hyperphenylalaninemia also had elevated arterial methionine concentrations. These observations suggest that many of the patients with sepsis had seriously impaired liver metabolism. In patients with fractures, the concentrations of ornithine (p less than 0.001), taurine (p less than 0.05), and aspartic acid (p less than 0.05) were lower than in controls. No other significant differences of amino acid concentrations were observed. It is difficult to relate these differences to a specific metabolic abnormality.


The effects of severe progressive hemodilution on regional blood flow and oxygen consumption. Electrolyte solutions are effective in the immediate treatment of hemorrhagic shock, but the acceptable limits of hemodilution are not well defined. In this study oxygen consumption was measured in various tissues at rest and in maximally exercising skeletal muscle during progressive hemodilution. Twenty splenectomized, anesthetized dogs were studied (weight 22.6 +/- 2.0 kilograms). Measurements were made of cardiac output, capillary muscle blood flow in the hind limb, and renal and superior mesenteric arterial blood flow. Arteriovenous oxygen differences in the hind limb, kidney, gut, and in the whole body were calculated from the oxygen content of arterial and appropriate venous samples.


Anaerobic infections in surgery: clinical review. Anaerobic bacteria are being recognized with increasing frequency as important micro-organisms in surgical infections. Clostridium, Bacteriodes, Fusobacterium, and Peptostreptococcus are the clinically prominent pathological anaerobes. All are commensals and, consequently, most anaerobic infections are endogenous in origin. In the colon, anaerobes are 1,000 times more prevalent than aerobes. This has important implications regarding the management of gastrointestinal tract operations and the treatment of infections originating from the bowel. Typical anaerobic infections include gas gangrene, brain abscess, oral infections, putrid lung abscesses, intra-abdominal abscesses, and wound infections following gynecologic and bowel surgery, perirectal abscesses, postabortal infections, and septic thrombophlebitis. Infections with anaerobic organisms must be suspected when there is feculent odor and/or gas production following gynecologic or bowel surgery, when there are organisms on gram staining but no growth on aerobic cultures, or when septicemia is associated with repeatedly negative blood cultures. Debridement and drainage constitute the main stay of treatment. All anaerobes are sensitive to chloramphenicol and clindamycin and all but Bacteroides fragils are sensitive to penicillin. Identification of anaerobes requires proper specimen sampling, immediate culturing on prereduced media, and careful gram staining of clinical material. The frequency of anaerobic organisms in surgical infections generally is not recognized by many surgeons; their importance needs to be stressed in the future.


Autologus saphenous vein femoropopliteal bypass: analysis of 298 cases. A retrospective review of 298 saphenous vein femoropopliteal bypasses performed for femoral artery occlusive disease over a 13 year period was carried out. The purpose of the study was to assess factors which influence long-term graft patency. Follow-up was 95.3 percent complete. Results were analyzed with the aid of IBM data processing equipment and standard statistical methods.


Localization of peripheral catheter emboli with xeroradiography. There is an increasing incidence of venous catheter emboli coincident with the prolonged use of both peripheral and central venous cannuli. Difficulty in localizing embolized catheter fragments frequently has been a problem, especially in the pediatric patient in whom nonradiopaque catheters are used. A case of catheter embolus in a 4-week-old infant is reported and the use of xeroradiography to localize the catheter in the soft tissue of the extremity is described. Xeroradiography offers excellent definition of soft tissue architecture and therefore may be of value in a variety of situations where localization of a foreign body proves difficult.


Renal function after thermal trauma: the effects of treatment on renal blood flow and sodium and water excretion. Effective renal plasma flow, urine sodium excretion, and glomerular filtration rates were reduced markedly to 44%, 46%, and 60% of normal, respectively, in rats subjected to thermal trauma. A sodium load of about 2 mEq. per 100 Gm. of body weight restores these functions toward normal. Doubling the concomitant water load had no discernible beneficial effect, but rats resuscitated with the larger water load were in greater positive water balance. These experimental data suggest that the water loads commonly administered clinically for the treatment of burn shock may be unnecessarily large.


Regional hemodynamics of large and small femoral arteriovenous fistulas in dogs. Alterations in regional hemodynamics were determined after construction of side-to-side femoral arteriovenous fistulas in dogs to quantitate the relationship between fistula size and reversal of distal arterial blood flow. When fistula size exceeded the transverse diameter of the femoral artery and vein (large fistula group), reversal in distal arterial blood flow was observed in all fistulas and measured 48 +/- 7 ml. per minute. If the fistula size were approximately equal to these critical transverse diameters (small fistula group), distal arterial flow was reduced but reversal did not occur. Distal arterial and venous pressures were 42 +/- 5 and 35 +/- 4 mn. Hg, respectively, for the large fistula group, and these pressures were 79 +/- 5 and 17 +/- 2 mn. Ht, respectively, for the small fistula group. These pressure changes for the two groups were significantly different and may provide a better understanding of the physiology of the reversal phenomenon.


Directional arterial flow velocity: a sensitive index of changes in peripheral vascular resistance. The effect of peripheral vascular resistance of directional arterial flow velocity was determined utilizing the directional Doppler velocity detector under experimental conditions. Femoral arterial resistance was increased and decreased, and arterial pressure, venous pressure, volume flow, and directional flow velocity were measured in the femoral artery. An increase in peripheral vascular resistance was associated with a marked increase in reverse flow and a decrease in forward flow velocity. Reverse flow decreased and forward flow velocity increased when resistance was lowered. The ratio of peak and mean reverse/forward (r/f) flow velocity changed in a linear relationship with vascular resistance. The increase in resistance associated with progressive hypovolemia was paralleled by an increase in r/f flow velocity which occurred before blood pressure declined. Thus alterations in directional arterial flow velocity can be used as a sensitive indicator of changes in peripheral vascular resistance.


Air embolization during the machine preservation of kidney. Air embolization during machine preservation of kidneys for transplantation occurred in seven of 218 kidneys. In three it occured during transportation on a portable machine. On arrival they had warmed up and were discarded. In four kidneys air embolization occured in the laboratory and was detected immediately. Upon re-establishment of perfusion, there was a sharply lower flow and a higher diastolic pressure. Within 30 to 120 minutes the flow reached the pre-embolization rate and the diastolic pressure stabilized at a slightly higher level than before embolization. One recipient died 2 months after transplantation due to infection, and one kidney was removed because of rejection after 32 days. Two patients receiving the mates to the above kidneys were discharged with excellent kidney function. If the exact time of air embolization cannot be determined, it is prudent to discard the kidneys. This indicates the importance of continuous supervision during the perfusion. When air embolization occurs in the laboratory and is detected immediately, the kidney should be evaluated carefully. If, after correction of the defect, the perfusion and diastolic pressure reach the neighborhood of pre-embolization levels within 30 to 120 minutes with no patchy discoloration, the kidney is suitable for transportation. Discarding kidneys with air emboli without proper evaluation is not justifiable.


Spontaneous rupture of the rectosigmoid colon with anal evisceration: a new complication of uterine prolapse. Spontaneous large bowel perforations have been associated with chronic constipation. The previously reported episodes of anal evisceration of small intestine have occurred in patients with a rectal prolapse. An end-stage complication of chronic third degree uterine prolapse is presented. A laceration of the anterior rectosignoid colon wall permitted small bowel extrusion through the anus. The tearing effect exerted by the prolapsed uterus at the rectouterine fold presumably caused the rectosigmoid laceration.


The nonoperative treatment of massive pyloroduodenal hemorrhage by retracted autologous clot embolization. Six patients with massive pyloroduodenal hemorrhage were treated by selective embolization of retracted autologous clot to occlude the bleeding vessels. All patients had severe associated illnesses and were very poor candidates for operative treatment. The actively bleeding vessel was occluded successfully and hemorrhage was controlled with autologous clot alone in five of these patients, although two patients later bled from other sites. Although three patients died, none died as a direct result of bleeding. The only complication encountered, multiple small hepatic infarct, occurred when the embolized clot migrated from the gastroduodenal artery to the hepatic artery. A method of avoiding this complication is presented. Selective emolization of retracted autologous clot represents a useful alternative to the operative management of massive pyloroduodenal hemorrhage and should be considered for the treatment of patients whose associated diseases make them poor candidates for operative treatment.


Giant esophageal leiomyoma with secondary megaesophagus. A 25-year-old woman presented with a giant leiomyoma in the lower third of the esophagus. She had no digestive symptoms, although there was a severe esophageal dilation. Such a megaesophagus secondary to a leiomyoma has not been described previously. Esophagogastric resection was performed, followed by an uneventful recovery period. The literature on esophageal leiomyoma is reviewed.


A pressure-measuring system for long-term in vivo pressure measurements. A new balloon-tipped catheter has been developed for the purpose of making long-term vivo intravascular pressure measurements. Among its advantages are its ability to electrically isolate the subject from the pressure transducer and be rebalanced and calibrated while in situ. Experimental results in calves indicate that the system provides a very reliable means of calibrating implanted catheter tip pressure transducers in situ and can be used as the primary long-term pressure measuring device when high frequency response is not required.


The mechanism of increased gallstone formation in obese human subjects. Cholesterol gallstones occur three times more frequently in morbidly obese subjects than in normal controls. The present study tests the hypothesis that obese subjects develop gallstones because of relative and absolute excess cholesterol excretion in bile. The steady-state kinetics of biliary lipid excretion and bile acid pool sizes were determined in eight healthy obese subjects without gallstones by a noninvasive technique. Aliquots of resting gallbladder bile were obtained on consecutive days. Hepatic bile excretion was constantly sampled during the infusion of a liquid isocaloric cholesterol-free formula containing a dilution indicator over two 12 hour periods on consecutive days. Gallbladder bile of seven of eight subjects was saturated consistently with cholesterol. Mean hourly hepatic cholesterol excretion in bile was 0.232 mM. per hour, three times greater than that of normal subjects and twice that of subjects with gallstones. Phospholipid and bile acid excretion were 0.73 and 1.88 mM. per hour, respectively. The excretion rates of these cholesterol-solubilizing components of bile are higher than in normal subjects but are insufficient to compensate for the increased cholesterol excretion. The bile acid pool sizes were normal (X = 2.72 Gm.) but the daily synthesis of bile acids was increased (X = 0.86 Gm. of cholic acid). We conclude that the clinically observed high correlation of cholelithiasis with obesity is due to increased hepatic secretion of cholesterol which precipitates as cholesterol gallstones.


A new vascular access for hemodialysis: the arterial jump graft. In seven patients in whom conventional vascular access for maintenance hemodialysis was not possible, a new access in the form of a femoropopliteal jump graft was employed. A follow-up of 3 months to 3 years (92 patient months) and an experience of more than 1,000 dialysis treatments have shown it to be a stable and satisfactory access.


Pneumatosis cystoides intestinalis: an unusual complication of jejunoileal bypass. A case of pneumatosis cytoides intestinalis associated with jejunoileal bypass is reported. The association of increased colonic gas, secondary to fermentation of undigested lactose in the colon, and the reflux of the excessive gas into the excluded segment of small bowel and dissection of the gas into the bowel wall and mesentery are postulated as the causes of pneumatosis cystoides intestinalis in patients with jejunoileal bypass.


(14C)Ethylenethiourea: distribution, excretion, and metabolism in pregnant rats. Following administration of single oral doses of [14C]ethylenethiourea (ETU) to pregnant rats maternal blood maintained peak radioactivity for 2 h, and  the radioactivity was dispersed uniformly between the red blood cells and plasma. The level of radioactivity was distributed equally among several maternal tissues but was present in lower amounts in embryos. Twenty-four hours after treatment all tissues examined, except blood, were relatively clear of radioactivity and 72.8% of the total radioactivity given had been excreted in the urine. Elution patterns of metabolites from Sephadex separation suggested that ethylenethiourea was degraded very little. The teratological mechanism is discussed.


High peptic stricture of the oesophagus. Fifty-seven patients with high peptic stricture and the lower oesophagus lined by columnar epithelium are considered from the clinical point of view. Information from 115 cases of low stricture is introduced for comparison. The average age of adult patients was 62 years with a sex incidence of 36 females to 21 males. There is little difference between the symptoms of high and low strictures. Radiologically, the majority of high strictures are short and smooth but other types are illustrated. Carcinoma and congenital mid-oesophageal web are considered in the differential diagnosis. There was an associated duodenal ulcer in 10% of cases. In six patients, a high stricture developed soon after an abdominal operation or period of recumbency. Two patients are illustrated showing the process of stricture formation. Four patients are described who had gastric-lined oesophagus but no ulceration of stricture. One patient had a Barrett ulcer in addition to a high stricture. A patient is described in whom the mucosa of the lower oesophagus appeared to be replaced by jejunal mucosa following oesophagojejunostomy. One patient is illustrated in whom a stricture was seen to ascend the oesophagus over a period of six years. Thirty-three patients were treated by dilatation and 24 by operation. Hernial repair is an effective form of treatment. Of 19 patients treated in this way, significant dysphagia persisted in two and slight dysphagia in one. The clinical findings are discussed in relation to the origin of columnar epithelium in the oesophagus.


Pulmonary varix.

Pulmonary varix. Pulmonary varix is a rare disorder which is usually discovered by change during the third to sixth decade in an asymptomatic patient. The 37th example is reported with a review of the literature. The disorder is possibly congenital and may affect any lobe. Pulmonary angiography is the preferred procedure for diagnosis. If symptoms are present, they can usually attributed to associated cardiopulmonary disease. Two serious complications have been reported--systematic embolus from a clot in the varix (two cases suspected), and rupture leading to the death of the patient (four cases). A third hazard to the patient is an unnecessary diagnostic thoracotomy. Patients without symptoms should have periodic chest radiographs of those with haemoptysis or systemic embolism should be considered for resection of the varix.


Mitral incompetence and ventricular septal defects following non-penetrating injury. A case of mitral incompetence and multiple ventricular septal defects following a non-penetrating chest injury is described. Cardiac injury was detected by electrocardiogram and by the appearance of a heart murmur in the second week after trauma. Superimposition of bacterial endocarditis seven years later caused cardiac decompensation and necessitated successful surgical treatment. Previous reported cases are reviewed.


Resection of a leiomyoma of the descending thoracic aorta. A primary aortic neoplasm in a 4-year-old asymptomatic boy is described. At operation the tumour was found to originate from the descending thoracici aorta. Histologically it proved to be a leiomyoma. The operative findings and pathological features are briefly discussed.


Pleuropneumonectomy in the management of diffuse malignant mesothelioma of the pleura. Experience with 29 patients. An analysis is made of the results of pleuropneumonectomy for diffuse malignant pleural mesothelioma in 29 patients and a comparison is made with the results of non-surgical treatment in a further 17 patients. A system of tumour staging is proposed, and the results are correlated with tumour stage and with histological type. Pleuropneumonectomy does not appear materially to affect the course of the disease in cases of mixed epithelial and mesenchymal histological type. However, stage I cases of pure epithelial histological type appear to carry a better prognosis, especially those whose histological structure consists entirely of abundant oedematous mucoid stroma with loosely arranged tumour cells. It is suggested therefore that only epithelial cases should be subjected to pleuropneumonectomy. Means of reducing operative mortality are discussed and alternative methods of treatment described.