Gallbladder disease. Prevalence in a South Wales industrial town. In a weighted random sample of the specially enumerated population of a South Wales industrial town, examined by cholecystography for gallstones, the overall prevalence rates were 6.2 per cent for men 45 to 69 years of age and 12.1 per cent for women of the same ages. Contrary to our expectation there was no marked increase in prevalence with age in either sex. Symptoms of dyspepsia said to be suggestive of gallstones were found with approximately equal frequency in those with and without gallbladder disease.


Correction of the permeability defect in hereditary stomatocytosis by dimethyl adipimidate. The effect of imidoesters on the extraordinarily increased cation permeability of hereditary stomatocytes was evaluated in erythrocytes from a splenectomized boy with persistent hemolytic anemia. Reaction of stomatocytes with dimethyl adipimidate reduced ouabain-associated potassium loss from 15 to 1.7 and sodium gain from 22 to 2.5 meq per liter of red cells per hours. Red-cell volume, cation concentration, and deformability, previously abnormal, rapidly became normal after stomatocytes were reacted with dimethyl adipimidate. Instead of stomatocytes, normal red cells and target cells were noted. The survival (half-time) of stomatocytes treated with 51Cr-labeled dimethyl adipimidate infused into rats rendered tolerant to human erythorocytes by pretreatment with ethyl palmitate and cobra-venom factor was double that of untreated stomatocytes. Chemical modification of the defect in vitro allowed stomatocytes to regain many properites of normal erythrocytes and favorably influenced the subsequent survival of these cells in vivo.


Research, the lifeline of medicine.

Research, the lifeline of medicine. Advances in medicine spring from discoveries in physics, chemistry and biology. Among key contributions to the diagnosis, treatment and prevention of cardiovascular and pulmonary diseases, a recent Comroe-Dripps analysis shows two thirds to have been basic rather than applied research. Without a firm foundation in basic knowledge innovations perceived as advances prove hollow and collapse. Strong social, economic and political pressures now threaten acquisition of basic knowledge. Scientists feel driven to undertake excessively complex problems and gamble against the historical record that science generally progresses by tackling discrete and well defined questions. Regardless of circumstances, professional standards require the physician and scientist to be creative and enlarge the fund of knowledge.


Increasing incidence of endometrial cancer in the United States. Data from eight areas in the United States served by population-based cancer reporting systems indicate that, after many years of relative stability, incidence rates of endometrial cancer have risen sharply in the 1970's. In some areas the amount of the increase has exceeded 10 per cent per year. The incidence among middle-aged women has changed most (by 40 to 150 per cent between 1969 and 1973, depending on the area), but rates have increased in younger women and the elderly as well.


Sweden's no-fault patient-injury insurance. Sweden has introduced a nationwide nofault patient-injury compensation plan. The plan was not introduced because malpractice insurance costs were high, but because so few injured patients received compensation through the tort liability system. With certain exceptions, compensation is provided for loss that occurs as a result of injury related to hospitalization or medical care. The insurance plan has completed 12 months of operation. It total cost is less than 50 cents per citizen, and it is financed from general tax revenue. Sweden's experience can be projected to a population the size of the United States, and the results compared to United States malpractice liability figures. Such a comparison indicates a total number of awards greater than that of the United States, but a lower average amount per award.


Progress toward a National Blood System. The American Blood Commission. The success of the American Blood Commission in improving the effectiveness and efficiency of blood service delivery in the United States depends on the Commission's interactions with its members, with HEW and with the Congress. Active involvement of over 36 national organizations as dues-paying members representing both consumer/donors and providers gives the Commission considerable influence. HEW underwrites specific programs of the Commission and HEW agencies display co-operation and re-enforcement of its moves. The Congress has refrained from actions that might undercut the effort. An all-voluntary blood-donor system is a key American Blood Commission objective. The argument for voluntarism is supported by the need to control hepatitis, but other means of controlling hepatitis may be developed. The Commission's plan for a national blood system is based on securing voluntary compliance with guidelines recommended by peer groups within the Commission, and should facilitate a more effective national blood-transfusion system.


Suppression of malignancy in human cells. Fusion between malignant and normal human cells results in the suppression of malignancy as measured by tumour formation. Malignant-malignant hybrids retain their malignant character. The human cell system has advantages for the study of the control of malignancy.


Genomic transcriptional activity and the structure of chromatin. Nucleic acid hybridisation has shown that micrococcal nuclease-derived chromatin subunits from the cells of Xenopus laevis contain fragments of ribosomal 28S, 18S and 5S RNAS within the population of 200 base-pair pieces of DNA. Subunits from cultured embryonic cells actively transcribing ribosomal RNA contain only 70-74% of the cistrons present in undigested wild-type DNA, while subunits from adult erythrocytes not active in RNA transcription contain close to 90% of the ribosomal cistrons in native chromatin.


Complete nucleotide sequence of bacteriophage MS2 RNA: primary and secondary structure of the replicase gene. Bacteriophage MS2 RNA is 3,569 nucleotides long. The nucleotide sequence has been established for the third and last gene, which codes for the replicase protein. A secondary structure model has also been proposed. Biological properties, such as ribosome binding and codon interactions can now be discussed on a molecular basis. As the sequences for the other regions of this RNA have been published already, the complete, primary chemical structure of a viral genome has now been established.


Genetic hypertension in rats is accompanied by a defect in renal prostaglandin catabolism. Noradrenaline releases prostaglandins in the kidney, and in rats these augment rather than reduce vasoconstriction produced by the amine. Homogenates of kidneys of New Zealand rats inbred for hypertension exhibit lower prostaglandin inactivation by 15-hydroxydehydrogenase than controls. At the same time, augmentation of noradrenaline vasoconstriction by the released prostaglandin is exaggerated. This biochemical defect could be the inherited abnormality primarily responsible for the development of hypertension in these animals.


Bicycle-pedal model for the first step in the vision process. Computer simulation of the molecular dynamics of retinal during its photoisomerisation inside a restrictive active site gives a detailed model for the sequence of events in the first step of the vision process. It is proposed that the prelumirhodopsin intermediate contains a strained all-trans retinal molecule produced directly and rapidly from the 11-cis, 12-s-trans conformation in rhodopsin by a bicycle-pedal isomerisation. The model reproduces the main experimental observations and explains how the protein makes the photoisomerisation path unique.


Messenger RNA for the coat protein of tobacco mosaic virus. TMV RNA is not an efficient template for translation of the viral coat protein, in spite of containing nucleotide sequences coding for the protein. Efficient translation requires the prior synthesis within infected cells of a smaller RNA carrying only a portion of the information encoded in the whole genome.


Nomograms for obtaining a necessary, minimum sample size. I. When distribution of data is normal. Four different nomograms were devised to obtain a necessary, minimum sample size at a 95% confidence rate when data were distributed normally. They corresponded to four different cases, the population of which was either infinite or finite and the permitted error of which was either mu--m or mu--m/s, where mu was population mean, m sample mean and s sample standard deviation. They could also be used for obtaining the confidence limits of the population mean from the data after having carried out a work.


[A histochemical study of acetylcholinesterase in intact and deafferented cat auditory cortex]. The peculiarities of the AChE distribution were investigated in the intact cat auditory cortex and during early period of its neuronal isolation. It is shown that in the isolated cortex slab the staining of the AChE containing fibre disappeared from the neuropile, while in the intact cortex it was well pronounced. AChE accumulation was observed in the proximal parts of the transsected thalamo-cortical fibres. It is supposed that the AChE-containing fibres in the auditory cortex belong to nonspecific thalamic inputs.


[Comparative characteristics of the background activity of neurons from several regions of the cerebral cortex of unanesthetized cats]. Neuronal background activity in associative (area 5) and certain projection regions (SI, AI, AII) of the cerebral cortex was studied in curarized cats. Different types of the neuronal activitke intervals distribution and autocorrelation function. All these statistical parameters indicated that the background activity of associative neurons significantly differed from that of projective field neurons. Bursts generation was the main peculiarity of the background activity of auditory cortical neurons. According to all the parameters studied the level of the background activity in the somatic sensory cortex was lower. The probable functional significance of these differences is discussed.


[Changes in the postsynaptic and spike potentials of a cortical neuron during habituation]. Changes in the spikes, EPSPs and IPSPs of neurons in the general cortex of the turtle forebrain were studied intracellularly during irregular repetition of light flasches. The amplitudes of these intracellular potentials decreased during habituation without any change in the resting potential. Their dependence on the membrane potential level changed. The short-latent evoked spikes decreased more considerably as compared with the spontaneous spikes and the spikes after IPSP. Probably, the decrease of the spontaneous spike and the spike after the IPSP reflects a nonspecific decrease in the excitability of a neuron because of the long intracellular recording so far as during extracellularly recording only the short-latent evoked spike decreased with habituation. The decrease of the short-latent evoked spike reflects neuronal habituation. A disinhibition of spikes and PSPs was observed. A suggestion is advanced that the pattern of synapses activated by a definite repetitive stimulus evokes a transitory change of the electrogenic properties of the neuronal membrane.


[Characteristics of the reactions of bat superior olivary neurons to single and paired ultrasonic stimuli]. Characteristics of single-unit activity in the superior olivary complex of Rhinolophus ferrum-equinum in response to ultrasonic stimuli with a pulse frequency within the echolocation range were studied. Some neurons were found to have three separate response areas with characteristic frequencies corresponding to one half and one third of the basic frequency ranging from 80 to 86 kHz. When the intensity of stimulus with a pulse frequency equal to the characteristic neuron frequency increased, the tonic response changed into phasic activity. With the use of two overlapping stimuli a change from phasic to tonic response occurred. The frequency of tonic discharge corresponded precisely to that of beats up to 2000 Hz (synchronism of neuronal discharges with each beat cycle). Synchtonized tonic activity persisted under specific pulse frequencies and stimulus intensities.


[Evoked potentials in the optic tectum of the carp brain upon electric stimulation of the facial nerve]. The evoked potentials in the carp tectum opticum in response to stimulation of the afferent pathway for chemical nonolfactory reception, the facial nerve, are positive deflections of 5-25 ms latency which do not reverse during microelectrode submersion. According to the evoked potential amplitude and latent period 7 active zones were distingnished in the ipsilateral tectum differing from each other either in one or in both parameters. The dependence of the response evoked by facial nerve stimulation in the tectum opticum on the impulsation from the medulla is proved by the difference in latency and by disappearance of the response in the tectum while persisting in the medulla after disconnection of both areas of the brain. The existence of efferent influences from the tectum upon the primary centre is suggested as the tectum ablation causes in some parts of the medulla either complete disappearance of the facial evoked potentials or changes in their parameters.


[The effect of stimulation of the posterior hypothalamus on the electrical activity of the neocortex in chronically premesencephalic cats]. Experiments were carried out on 19 adult cats with chronic brain stem transections at the level of the foremost border of the supperior colliculus. High-frequency electric stimulation of the posterior hypothalamus produced in these cats desynchronization of electrical activity in different parts of the neocortex. A predominant influence from the posterior hypothalamus on the electrical activity of frontal lobes was observed. On the basis of the obtained data, it is suggested that the influences from posterior hypothalamus elicit neocortical activation via thalamic nuclei.


[Afferent activity in fine myelinated and unmyelinated nerve fibers of a cutaneous nerve upon mechanical stimulation of cutaneous receptors]. The activity in fine myelinated and nonmyelinated nerve fibres of a cat cutaneous nerve was analyzed using a collision method and method improving the signal-to-noise ratio in the antidromic action potential neurogram. On the basis of the investigation of conduction velocities, electrical excitation thresholds and responses to mechanical stimulations, the following groupsare distinguished among fine myelinated and nonmyelinated fibres: group A delta1 (30-14m/s) activated mostly under light mechanical stimulation; group A delta2 (14.4.0 m/s) more readily activated by intense mechanical stimulation; group of "mixed" fibres containing myelinated and nonmyelinated nerve fibres (4-2 m/s) activated under both kinds of mechanical stimulation; group C1 (2.0-1.0 M/S) ACTIVATED MOSTLY BY LIGHT Mechanical stimulation and group C2 (1.0-0.15 M/S) CONNECTED WITh receptors that require for excitation intense mechanical stimulation.


[Reactions of medial geniculate body neurons to stimulation of the auditory cortex]. Extra- and intracellular responses of pars principalis neurons in the medial geniculate body to stimulation of the first (AI), second (AII) and third (AIII) auditory cortex were studied in experiments on cats immobilized with d-tubocurarine. In geniculate neurons both antidromic (45-50%) and orthodromic (50-55%) reactions occurred in response to the auditory cortex stimulation. The latencies for antidromic and orthodromic responses were 0.3-2.5 ms and 2.0-ms, respectively. Late responses appeared with a latency of 30-200 ms. 63% of neurons responded antidromically to both AII and AI stimulation, that confirms the suggestion on the projection of a considerable number of the geniculate neurons to both auditory zones. Orthodromic responses of geniculate neurons consisted either of 1-2 spikes or a burst of 8-12 spikes with a frequency of 300-600/sec. The bursts are supposed to be the responses of inhibitory geniculate neurons. Intracellular recording showed the following responses: antidromic spikes, EPSP, EPSP-spike, EPSP-spike-IPSP, EPSP-IPSP and initial IPSP. Above 50% of initial IPSPs had the latency of 2.0-4.0 ms. They are supposed to be produced with the participation of intermediate inhibitory neurons located in the medial geniculate body.


[Conduction pathways of the solar plexus in dogs]. The conduction pathways of dog's solar plexus were studied, using the recording of action potentials of the plexus nerves. Greater splanchnic nerves consists of two groups of afferent A-fibres (conduction velocity of 12-15 and 25-56 m/s), afferent C-fibres (conduction velocity of 0.4-2.0 m/s) and preganglionic B- and C-fibres (conduction velocity of 1.0-12.0 m/s). Afferent A- and and C-fibres pass through the solar plexus ganglia to the dorsal roots; preganglionic fibres terminate synaptically on ganglionic neurons, their axons pass in the peripheral nerves to the viscera. Pathways between the peripheral nerves were found; probably they form peripheral reflex arcs.


[The growth of axons in the periphery after a decrease in the quantity of nerve cells in sympathetic ganglia]. The amount of cells in stellate ganglia of rat was decreased by chemical sympathectomy to 30% of the normal amount. At the age of two months sympathectomized rats have no pressor reflexes to asphyxia and femoral nerve stimulation. These responses are restored at the age of four months. The electron-microscopic and fluorescence-microscopic data show that the growth of axons in the remaining adrenergic neurons of sympathectomized animals takes place at the age between two and four months.


[Anatomic correlation between several cortical and subcortical brain structures]. Investigation of frontal brain sections of 10 cats, 30 dogs and 20 people revealed a topographic correlation between certain cortical and subcortical structures: the beginning of fissura. Sylvii (the so-called "fossa Sylvii") and commissura alba cerebri anterior are located always in the same stereotaxic frontal plane. A method of practical application of the revealed topographic correlation is suggested for the stereotaxic operations on higher animals and human beings.


Renal handling of the third (C3) and fourth (C4) components of the complement system in the nephrotic syndrome. Complementuria is a common finding in patients with heavy proteinuria from a variety of causes, and was detected in 23 out of 34 nephrotic subjects. Mean excretion of C3 and C4 in these patients was 49 +/- 22 and 14 +/- 3 mg/24h, respectively. The renal handling of complement appears to be largely molecular weight (MW) dependent, an inverse relationship between the sieving coefficient and  MW of transferrin, IgG, C3, and C4 obtaining, in nephrotic patients irrespective of the nature of their glomerulopathy or degree of renal function. Furthermore, glomerular sieving of C3 and C4 was not significantly different in patients with immune glomerular injury associated with extensive glomerular complement deposition, from that in patients with non-immune glomerulopathy, suggesting that no unique mechanism exists for the transglomerular passage of complement from serum into the urine of the former group. The finding of a large increase of sieving of C3 and C4 in nephrotic patients with end-stage renal failure may indicate a failure by atrophic tubules to reabsorb and catabolize filtered complement.


1alpha-hydroxycholecalciferol. Long-term treatment of patients with uraemic osteodystrophy. Three adolescents with uraemic osteodystrophy were treated for 7 months with daily oral doses of 1alpha-hydroxycholecalciferol (0.25-10.0 mug). All the patients were hypocalcaemic and had high serum levels of alkaline phosphatase before the treatment. A rapid rise in serum calcium and a slow, but pronounced decline in serum alkaline phosphatase concentration were observed during the period of treatment. 1alpha-Hydroxycholecalciferol induced hypercalcaemia in two situations. In both cases the hypercalcaemia was transient, serum calcium being normalized in a few days by withdrawal of the drug. Withdrawal of the drug also in other situations resulted in a fall in serum calcium concentration in a couple of days. This suggests that 1alpha-hydroxycholecalciferol should be given daily or every other day. The response did not subside during 7 months of treatment. On the contrary, the maintenance dose necessary to keep serum calcium constant was smaller than the initial dose necessary to normalize serum calcium. Bone mineral content, estimated by photon absorptiometry, rose. The rachitic bone lesions seen radiologically were significantly ameliorated during the treatment.


Uremic pericardial effusion. Treatment by catheter drainage and local nonabsorbable steroid administration. Pericardial drainage via percutaneous catheter placement and local nonabsorbable steroid instillation was employed as definitive therapy for uremic patients who had intractable pericardial effusions. Twelve patients are reported. Prior daily dialysis, and in one case systemic steroids, were not curative. 11 of 12 cases suffered severe tamponade requiring pericardiocentesis. One patient had an organized pericardial effusion, making pericardiocentesis impossible. He required pericardiectomy with prolonged hospitalization (2 weeks) due to postoperative complications. There were no complications in the 11 patients where catheter drainage and local steroid instillation were employed. No patient had recurrence of his pericardial effusion (followed from 2 weeks to 32 months). Instillation of a relatively nonabsorbable steroid through an indwelling pericardial catheter provides immediate and lasting relief without either the inconvenience or postoperative complications and prolonged hospitalization associated with the surgical procedure of pericardial fenestration. This report offers initial evidence that the percutaneous approach may be a safe and effective alternative to pericardial fenestration in most uremic patients with pericardial effusion.


Increased prevalence of coronary heart disease in analgesic nephropathy: relation to hypertension, hypertriglyceridemia and combined hyperlipidemia. The prevalence of coronary heart disease (58%) in 43 patients with analgesic nephropathy with moderate to severe chronic renal failure was significantly higher than in the general population of the same age and sex. Mean serum triglyceride concentration and mean diastolic blood pressure were significantly higher in the group with coronary heart disease (214 mg/dl and 102 mm Hg, respectively) than in the group without it (162 and 94). Serum triglyceride values correlated inversely with GFR, indicating that hypertriglyceridemia was largely due to associated chronic renal failure; a specific effect of analgesic abuse on prevalence of heart disease, noted by others, could not be assessed in the absence of GFR-matched controls. The prevalence of coronary heart disease was significantly higher (81%) in the group with combined hyperlipidemia (hypertriglyceridemia and hypercholesteremia) compared to the groups without it or with normal serum triglyceride concentrations (44 and 41%, respectively). Hypotryptophanemia (a possible cause of hyperlipidemia in the nephrotic syndrome) was present in 77% of patients.


Glomerular basement membrane antigens in congenital and acquired nephrotic syndrome in childhood. Urinary and serum glomerular basement membrane (GBM) antigens were detected by immunodiffusion in patients with nephrotic syndrome and in healthy subjects. The excretion of urinary GBM antigens was greatest in patients with congenital nephrotic syndrome of Finnish type (CNF) and in patients with acquired, therapy-resistant nephrotic syndrome who had a variety of histologically identified glomerular lesions. One GBM antigen, indistinguishable from the urinary one, was also detected in the serum of four of these patients. Excretion of urinary GBM antigens was within normal limits, in patients with steroid-sensitive nephrotic syndrome with minimal changes in renal histology and in the parents (heterozygotes) of CNF patients.


Multinucleated giant cells in antiglomerular basement membrane antibody-induced glomerulonephritis. Inflammatory giant cells were found in close association with glomerular basement membrane in a case of rapidly progressive glomerulonephritis. It is suggested that this finding is due to an alteration in properties of the glomerular basement membrane most probably brought about by circulating antibody to basement membrane.


Population genetics of Alport's syndrome. Hypothesis of abnormal segregation and the necessary existence of mutation. The diagnosis of Alport's syndrome is generally not considered in the absence of a positive family history. Family studies indicate that transmission occures by a rare autosomal dominant gene. The deviation of transmission ratios from the classical Mendelian pattern is best explained by abnormal segregation. Based on observed pedigree data, calculations were made of the expected equilibrium population frequency of Alport's syndrome assuming mutation rates of zero, 10, and 50 per million gametes. Zero mutation rate should result in disappearance of the Alport gene. An equilibrium frequency corresponding to that actually observed in Rhode Island implies a mutation rate of 10 per million gametes. Furthermore, up to 18% of all newborns with the Alport genotype may represent new mutants. Thus, isolated cases of Alport's syndrome may occur in the absence of other affected family members.


Renal arteriolar obstruction without hypertension. Selective partial occlusion of the intrarenal arteriolar bed with microspheres in rats resulted in contracted kidneys simulating those of benign nephrosclerosis in man. There was no elevation of blood pressure, renal vein plasma measured by radioimmunoassay, or juxtaglomerular indices of affected kidneys. It is unlikely that arteriolar lesions are pathogenetically related to the development of hypertension.


Effect of dose on renal diatrizoate concentrations in experimental acute renal failure. In rats with glycerol-induced acute renal failure (ARF) and controls, renal concentrations of 125I-labelled sodium diatrizoate were measured 5 min after intravenous doses ranging from 14 to 1,800 mg/kg body weight. Renal concentrations of diatrizoate, at all doses, were much higher in controls than in ARF. A linear relationship existed between dose and renal concentration in ARF. In controls, at doses above 225 mg/kg body weight, the fraction of the dose present in the kidneys diminished and renal iodine content approached that observed in ARF. Differences in diatrizoate concentration which existed between cortical and medullary zones in healthy kidneys at low dises were progressively eliminated as dosage increased, consistent with the osmatic fiutryiv rggrvy of diatrizoate. In ARF, the pattern of intrarenal distribution at all doses was similar to that seen in controls at high doses, though concentrations in outer cortex were consistently slightly higher than those in inner cortex. These observations suggest continuing though reduced, filtration of diatrizoate in ARF by glomeruli already subjected to a large solute load.


The effect of plasma calcium on plasma ADH levels in anephric patients. Ten anephric patients were studied before and during hemodialysis. The extracorporeal circuit was primed with 5% albumin in 0.9% sodium chloride. Ultrafiltration volume removed by the hemodialyzer was replaced continuously. Modifications of a standard chronic renal failure dialysate were used to minimize changes in plasma urea while varying plasma sodium and calcium in opposite directions. Plasma ionized calcium concentrations in two patients confirmed other studies demonstrating a correlation between plasma total calcium and ionized calcium under these conditions. Plasma ADH determined by bioassay did not correlate with plasma osmolality, plasma sodium concentration, plasma potassium concentration, blood pressure, or pulse rate. The change in plasma ADH during dialysis was significantly correlated only with the change in plasma calcium (r = 0.47, p less than 0.05). The data support the hypothesis that plasma calcium plays a role in the regulation of ADH release in man, independent of the renin-aldosterone system.


Trans-sphenoidal surgical approach in pituitary apoplexy. Two cases are described presenting a clinical picture of sudden headache, fever and vomiting, accompanied by unilateral ophthalmoplegia and acute deterioration of visual acuity. In one this amounted to monocular blindness with a field defect in the other, indicative of chiasmal compression. Necrotic pituitary adenoma material was removed by the transphenoidal route in both cases. Recovery of eye movements was obtained and considerable improvement of visual acuity, which in one patient, was restored completely.


Cerebral cavernous haemangiomas or cavernomas. Incidence, pathology, localization, diagnosis, clinical features and treatment. Review of the literature and report of an unusual case. Reviewing the literature and adding one unusual case the features of 164 cerebral cavernous haemangiomas are described with special reference to incidence, localization, diagnosis and clinical findings. Cavernomas may be found in every age group including the neonatal period. The sex incidence is equal. In 126 cases (76.8%) the cavernomas were of supratentorial, in 34 cases (20.7%) of infratentorial site, and in 4 more cases (2.5%) there was multiple occurence of supratentorial and posterior fossa cavernous haemangiomas. A specific clinical syndrome could not be defined: but the course is usually acute or subacute, and initial symptoms are commonly epileptic fits, acute headache and subarachnoid or intracerebral haemorrhage. Macroscopic calcifications of cerebral cavernomas were found only in 18 cases (11%). Cerebral angiography was done in 31 cases (18.9%). In 9 cases angiography was totally normal, and in 11 cases the cavernoma presented only as an avascular mass. In the remaining cases there was no conformity in the angiographic appearance of cerebral cavernous haemangiomas. Operative extirpation is the treatment of choice if a solitary lesion is favourably located. In addition to our patient there are now 21 cases (12.8%) in which cavernomas were treated successfully by operative extirpation.


[Pain phenomena in amputees. Clinical features, evaluation of tests and possibilities of treatment (author's transl)]. The clinical phenomena in amputees can be clearly divided into phantom pain, painful stumps and stump pulsation. The various causal mechanisms are described as a basis for the differing assessments of treatment and also compared with our own observations and results.


[Cerebral accidents, psychic manifestations, spinocerebellar disturbances and brain tumour (author's transl)]. At the age of 35 years the patient was affected by epileptic attacks. Two years later psychic changes, vomiting and unsteadiness of gait were noted and not only in the EEG but also in the angiogram, the suspicion of a right hemisphere tumour was expressed. The operation was postponed because the patient's husband was afraid of complications. In the following years other doctors who were concerned with the diagnostic problem, either missed the significance of the existing symptoms or did not attach enough importance to them. As a result of an operation (uterine fibroids) and also because of a slight head injury, an increase in the neurological and psychiatric symptoms was brought about and fortunately this prepared the way for the correct treatment. After the operation there was a significant improvement not only in the psychiatric, but also in the neurological state. As a result of the advanced state of the tumour growth (oligodendroglioma) it was only possible to carry out a sub-total removal. A review of the case indicates that a closer neuropsychiatric and neurosurgical co-operation might have led, at the earliest ten or at the latest five years previously, to a successful outcome of the operation.


[Chronic adhesive leptomeningitis of the cauda equina as a cause of ischaemic disturbances (author's transl)]. An almost typical sciatic syndrome can be occasionally associated with a thickening of the leptomeninges, producing a type of chronic fibroplastic meningitis in the region of the cauda equina. We report here four personal cases, which showed atypical myelographic patterns. The roots of the cauda equina were compressed both by the cystic and by the fibrosing types. In the cases described, the removal of the altered leptomeninges under the operating microscope produced a satisfactory result. A completely symptomfree outcome can rarely be achieved, as the pathological tissue cannot be completely removed.


[Early diagnosis and prevention of severe forms of epilepsy]. Early diagnosis and treatment are the basis of prevention of severe forms of epilepsy. In order to determine the beginning of the process the author studied 400 cases in which the duration of epilepsy ranged from several weeks to 3 years. The investigations demonstrated that epilepsy develops in subjects presenting certain premorbid symptoms and signs. The "epileptic process" develops frequently as a result of past infections and craniocerebral injuries followed by residual neurological signs and cerebrasthenia. Seizure attacks, if no additional releasing factors are present, are preceded by various clinically weakly expressed seizure phenomena. They include peculiar,very vivid dreams, sudden awakenings with partly obnubilated consciouness and a feeling of fear, abortive psychomotor and other seizure. The "microseizures" include also myoclonic twitches preceding sleep and during sleep, auras, brief viscerovegatative attacks, opercular symptoms, symptoms of dream-like states, twitches of isolated muscles without consciousness disturbances. In 44% of cases asthenic symptoms were present in connection with microseizures. They served as background for development long-standing irritative foci manifesting themselves clinically with sluggishness of thinking and affect and compulsive features. Presence of these microseizures may suggest epilepsy long before appearance of typical seizures and may be an indication to beginning of treatment which may prevent the development of severe epilepsy. The syndrome of seizure-like microsymptoms makes it possible to recognize the prodromal stage of epilepsy and to change our views on its sudden onset.


[Possibilities of psychoprophylaxis in epilepsy]. The psychiatrist should be given also their share in the prevetion of epilepsy by means of raising the psychiatric culture of the society and teaching the population the principles of mental hygiene and psychoprophylaxia. The possibilities of psychiatry in prophylactic management of patients with developed epilepsy include: 1. Energetic measures for controlling attacks which has many psychoprophylactic aspects. 2. Prevention of psychotraumatizing situations leading to secondary neurotic, psychotic and other reactions and behaviour disorders of the type of homilopathy and sociopathy, 3. Counteracting the development of mental and social disability in epileptics. Treatment of epilepsy should be conducted from its very beginning in cooperation with psychiatrists and therapeutic psychologists. The probems of prophylaxis cannot be separated from prophylactic treatment, psychotherapy sociotherapy and rehabilitation.


E1Intensive therapy and prevention of epilepsy in newborn infants. On the basis of an analysis of the material from the Department of Neonatology, Institute of Gynaecology and Obstetrics, Medical Academy in Poznań the authors evaluated clinical seizures and their electroencephalographic correlates in the perinatal period. Attention is called to scant clinical symptoms despite frequent seizure activity in EEG. The authors describe the principles of comprehensive treatment in the first days of life.


[Factors determining favourable or unfavorable results of treatment of epilepsy in children in the light of follow-up observations]. The described material was divided into two groups. Group I (45,6%) without seizures since 3 years at least, group II (54.4%) with continuing seizures (in 52% of this group the intensity of seizures remained unchanged and in 48% it decreased). The factors determining successful treatment included: unestablished or traumatic aetiology of seizures, partial-simple type of seizures, normal neurological status and normal psychomotor development at the time of onset, small number of seizures prior to beginning of treatment, good effects of drugs. The factors which might determine therapeutic failure included: presence of organic CNS type of seizures (primarily generalized, myoclonic, salaam seizures, and partial secondarily generalized seizures), the dynamics of the disease (frequent refractory seizures), late beginning of treatment. The morphological features of initial EEG tracings in without prognostic significance. In most cases with a favourable course improvement of normalization of EEG tracings was observed, with disappearance of seizure activity followed by regression of focal changes and by normalization of background activity.


[Problem of epileptics not undergoing treatment]. Among 98 epileptics found in the sample of general population 1/3 were on anticonvulsants when examined, another 1/3 were medicated in the past and a remaining 1/3 never received any medication. Out of 312 samples epileptics known to specialty facilities, 75% were on treatment when examined. Voluntary cessation of medication was frequently observed in both samples of epileptics. Milder epilepsy cases were underrepresented among the patients currently on medication, and significantly more frequent among those who never have been treated or ceased medication on their own. The results of the study show that in some proportion of cases seizures may disappear without treatment, and that prolonged medication may be not the only cause of disappearance of seizures. Moreover, early discontinuation of treatment must not always be followed by recurrence of seizures. Thus, medical prognosis in epilepsy seems to be far better than it has been accepted on the basis of studies on patients known to doctors and medicated for years. Implications of the above results for prevention in epilepsy are discussed briefly.


[Causes of epilepsy in children and possibilities of its prevention]. A seven year follow-up of an unselected group of 1964 children served for establishing the incidence and causes of epilepsy development. The analysis of the health state of the parents, fetal life and birth of this group of patients and a similar analysis of 576 epileptic children treated at the Department of Neurology, Medical Academy in Gdańsk demonstrated a statistically significant correlation between the incidence of epilepsy and the course of pregnancy and labour. It was found that all harmful factors acting on the fetal brain create a specific predisposition to seizure responses of the brain, either spontaneous (epilepsy) or provoked by other factors (e.g. fever induced seizures). Discussing the possibility of epilepsy prevention the author stresses the necessity of reducing the number of pregnancy and labour complications by raising the standard of care of pregnant women and women in labour.


[Analysis of the possibilities of prevention of status epilepticus as well as its complications in children]. Sixty-five cases of status epilepticus in 51 children were analysed. In 8 cases permanent damage to the CNS resulted and 4 children died. The analysis indicates that the factors influencing the frequency of status epilepticus and CNS damage include: young age of children, infections and their type, withdrawal of antiepileptic medication and the time of beginning treatment of status epilepticus as well as the type of drugs used. In prevention of repeated seizures the authors suggest early administration of anticonvulsants with dehydrating drugs, antipyretics and anti-inflammatory agents. The authors suggest also increasing of the dosage of anticonvulsants in cases of enen common infections beginning in epileptic children.


[Occupational interests of epileptic children and possibilities of their realization]. The purpose of this study was an analysis of occupational interests and their relationship to the intellectual capacities of epileptic children. Thirty-three children (20 girls and 13 boys) from the 8th class of elementary school were studied. They had been under treatment for 3 years, at least. The study was performed using the General Classification Test and the Technical Thinking Test. The investigations demonstrated that the girls were interested in humanistic fields while the boys in agriculture and technique. In relation to healthy children the level of occupational aspiration was lower in these children, particularly the boys. The children explained lowering of their occupational aspirations with low intellectual abilities. This motivation has, however, not been confirmed by the results of tests. The authors put forward the hypothesis that lowering aspirations may be also caused by erroneous attitude of the community towards these children.


[Resocialization of epileptics in the opinion of psychologists at the Epilepsy Outpatient Clinic in Posnań]. The investigations were carried out at the Outpatient Epilepsy Clinic in Poznań and they were connected with three main problems: family situation, possibility of education, vocational training and work ability of epileptics. The method of programmed clinical history talking with the patient was used and it was supplemented by a talk with a family member. The results of these investigations demonstrated that epileptics after completion of elementary school should be advised to continue education in elementary or secondary vocational schools. In cases of inability to continue work in the acquired occupation the patient should be advised to learn another occupation and only in exceptional cases of application for work disability status should be indicated. In family counseling coexistence of other diseases and the mental status of the patient and possible diseases of the marital partner should be taken into account.


[Effect of parent attitudes on the development of psychomotor disorders in epileptic children]. The authors studied the problem of parental attitudes assuming that in epilepsy, besides the coexistent CNS damage, the intensity and frequency of convulsive seizures, and the mode and duration of treatment which influence the functions of the child, the attitude of the parents is also very important. In the studied material of 272 cases (146 boys and 126 girls) treated in the psychiatric department and out-patient clinic in the Institute of Paediatrics, Medical Academy in Warsaw for at least 3 years three main patterns of parental attitude towards the epileptic child have been recognized: 1. overprotective attitude (58%). 2. inconsistent attitude (32%). 3. rejecting attitude (8%). Depending on these attitudes certain disturbances of psychomotor development manifested themselves or intensified, mainly in the form abnormal development of emotions and cognitive functions as well as social adaptation. In the conclusions the authors stress the widespread occurrence of incorrect parental attitudes and the necessity of psychotherapeutic influence on the parents.


[Prevention of inappropriate bringing up of epileptic children by their families]. The author studied the cognitive and emotional aspect of parental attitudes towards the epileptic children using a modification of the Schaefer and Bell "PARI" questionnaire. Additional information was obtained during history taking from the mothers and from the analysis of case records. The studies were carried out on mothers of epileptic children and mothers of children without epielpsy and other chronic diseases. The obtained results indicate that there is a significant difference between the attitudes of mothers of epileptic children and those of healthy children in the aspect of "excessive distance" and "excessive concentration" in favour of the mothers of non-epileptic children. No significant difference was found in "normal emotional contact". In view of this pattern of parental attitudes directives are suggested for correction of errors made by mothers of epileptic children.


[Effect of diphenylhydantoin on a developed epileptogenic focus in cats with split cerebral hemispheres]. The purpose of this work was to assess the effects of DPH on a developed epileptogenic focus in cats with split cerebral hemispheres. The investigations were carried out on 12 cats with a chronic epileptogenic focus produced by means of aluminum method in the right motor area. In all cats the epileptogenic focus was found in EEG. All animals received DPH in daily doses of 8-15 mg/kg. In 2 cats they appeared before beginning of treatment. One of these cats died after 3 days from status epilepticus, the other survived status epilepticus and died after 42 days of DPH administration with signs of intoxication. In 3 cats clinical seizures developed during DPH treatment after 30.84 and 210 days. DPH was given during from 171 to 314 days. Clinical seizures appeared in these cats only sporadically and the animals were sacrificed after completion of investigations. In 7 out of 12 cats clinical seizures failed to develop despite presence of bioelectrically active epileptogenic seizures in the right motor area. Administration of DPH in cats with developed epileptogenic focus failed to prevent clinical seizures. In cats with seizures their control was limited by drug toxicity. In all animals toxic effects were observed although the serum DPH level was in the range 8-20 mug/ml.


[Objective assessment of the effects of 5'5-diphenylhydantoin on cat motor activity]. The authors report the preliminary results of determinations of motor activity of cats receiving 5'5-diphenylhydantoin. The determinations were carried out by means of a special device recording all movements of the animals to ensure objective evaluation. Healthy cats were used for these experiments. They were giving DPH in doses up to 12 mg/kg daily, the maximal dose was reached gradually over a period of one month. It was found that in the observed time period several activity peaks occurred at night time from 6 p.m. to 6 a.m. These peaks were a stable phenomenon in a given cat but they varied from one animal to another. Thus the results could be compared in one cat only. During administration of DPH afall of general activity to 50% occurred, the "great" activity was reduced or even disappeared completely, and the periods of increased activity were changed.


[Effect of epileptagenic focus on the process of learning and memory in cats]. Investigations were performed on 13 cats with epileptogenic focus developed after sectioning the optic chiasm and corpus callosum. Learning was begun 3 months after producing the epileptogenic focus by the aluminium method when it was bioelectrically active. Additionally in 6 cats DPH in daily doses of 10--15 mg/kg was given 3 months after development of the focus. Learning of these animals was begun 1--2 months after the beginning of DPH administration which was continued throughout the whole period of learning during a 3-month pause in learning, as well as at the time of memory testing. In all animals the time of conditioned reflex development and differentiation was delayed. Learning was more difficult in animals with epileptogenic focus receiving DPH than in the animals with the epileptogenic focus not receiving DPH. Learning was slightly worse in the hemisphere with the focus than in that without the focus. Presence of clinical epileptic seizures was without any significant effect on the time of learning with the exception of days on which clinical seizures occurred (the percent of responses was then lower). Disturbances of memory of acquired conditioned reflexes were found only in animals with clinical seizures.


[Changes in cytohormonal cervical swabs in epileptic women]. In 16 women with epilepsy aged 18 to 38 years cytohormonal investigations were carried out during menstrual cycle. Swabs were obtained from the upper one-third of the vagina, fixed and stained by the method of Schorr. Oestrogen activity indices (PI, EI, MI) and progesterone activity indices (FI, CI) were calculated. With the exception of 2 cases in all patients the cycles were abnormal. In 1 cycle high values of oestrogen activity indices were found. In 13 patients (80%) monophasic, hypoestrogenic, cycles were observed without progesterone activity in the second phase of the cycle. The authors believe that very long anticonvulsant treatment as well as lower efficiency of the hypothalamo-hypophyseal system may reduce the level of steroid hormones produced by the ovaries which must, however, be confirmed by further clinical and experimental investigations.


[Electrochemical blood properties in epileptic children]. The cell-plasma index of sodium and potassium ions was determined in 15 children with the diagnosis of epilepsy. Sodium and potassium were determined in the erythrocytes and plasma by means of flame photometer. Then the interphase electrical potential of these ions was calculated and compared with similar determinations in healthy children. In the epileptic children the index of Na ions was increased and that of K ions decreased. The index of cell-plasma distribution of these ions was increased also. Electrical interphase potential of these ions was 1.38 mV lower than in healthy children.


[Post-traumatic intracranial bleeding in epilepsy]. The authors describe 11 cases of intracranial haemorrhage developing during grand mal attacks. The attacks were frequent or very frequent, sometimes they were connected with withdrawal of anticonvulsant treatment or alcohol abuse. In the clinical pattern of changes disturbances of consciousness predominated together with signs of increasing intracranial pressure. In only one case subarachnoid haemorrhage was recognized, in the remaining cases multiple or single intracranial haematomas were found and treated successfully surgically. The possibility of traumatic origin of intracranial haemorrhages may be suggested by presence of cranial fractures. In the material of the authors intracranial bleedings were present in 40.2% of epileptic patients who suffered craniocerebral injury during a seizure.


Predictive value of cervical dilatation rates. I. Primipara labor. A modified version of Philpott's partogram was used to analyze primipara labor in Israel. The rate of cervical dilatation measure early in the active phase of labor (initial rate) is an accurate indicator of the outcome of labor. Ninety-three percent of primiparas with an initial cervical dilatation rate of 1.00 cm/hour or more delivered spontaneously. Seventy-six percent of those with an initial cervical dilatation rate of less than 1.00 cm/hour required an assisted delivery (forceps or vacuum) or cesarean section. The mean cervical dilatation rate for spontaneous deliveries as measured early in the active phase was 1.75 cm/hour. Patients needing an assisted delivery had a mean cervical dilatation rate of 0.93 cm/hour, and for cesarean section deliveries the mean rate was 0.42 cm/hour. No significant differences were observed among patients of different ethnic origins. The initial cervical dilatation rate proves to be useful in early identification of those patients who deliveries were complicated. The method avoids complicated cervicographs and is simple and reliable.


The effect of unselected intrapartum fetal monitoring. Experiences with unselected intrapartum fetal monitoring in the 3-year period from 1972-1974 are compared with those of the 3 preceding years before monitoring was instituted. The effect of monitoring all laboring patients is correlated with a significant decrease in the perinatal mortality and a significant increase in the cesarean section rate. There were 16 intrapartum deaths during the period before monitors were used compared to only 1 intrapartum death in the period when monitors were used. The advantages and disadvantages of unselected electronic monitoring are discussed. The importance of education of medical and paramedical personnel necessary for intense intrapartum care is emphasized.


Postpartum and Postabortal Ovarian Vein Thrombophlebitis. Six cases of ovarian vein thrombophlebitis are reported including one resulting in operative death, a case diagnosed by phlebography, a postabortal case, and a case followed by habitual abortion. An historic review of this disease is presented. It is suggested that the ovarian vein may be the most commonly involved vein in puerperal pelvic thrombophlebitis.


Effects of terbutaline on human myometrial activity and endometrial blood flow. The selective beta2-receptor stimulator, terbutaline (0.25-0.5 mg), was given intravenously to healthy women at different times in the menstrual cycle. Intrauterine pressure was recorded by means of a microtransducer catheter, and local endometrial blood flow followed by a thermistor technic based on measuring thermodilution. The general response to terbutaline was a decrease in uterine activity and an increase in blood flow. However, the effects varied with the menstrual phase, being maximum around the onset of menstruation and minimum at midcycle. Pretreatment with propranolol (1 mg IV) completely inhibited the effects of terbutaline.


The Cervical Epithelium From Fetal Age to Adolescence. Uteri obtained at the postmortem examination of 164 girls ranging in age from premature and immature infants to 11 years were studied for evidence regarding the developmental changes that take place in the cervix during this period of life and in particular the mechanisms involved in the production and regression of congenital ectropion. Tt is concluded that congenital ectropion is a normal feature of development of the cervix.Its occurrence and its persistence or disappearance appear to depend on variable growth of cervical tissues as they react to hormonal stimulation, hormonal deprivation, and systemic growth. The mechanisms are described in detail.


Management of Postoperative Abscess Following Gynecologic Surgery. Forty-nine postoperative abscesses were encountered following 1600 major pelvic procedures. Abdominal and vaginal procedures were complicated by abscess formation in 0.7% and 4% of cases, respectively. The average time between surgery and recognition of the pelvic abscess was 18 days. A positive correlation between surgery performed during the luteal phase and abscess formation was noted. Fifty-five percent of pelvic abscesses treated by primary vaginal drainage required eventful laparotomy for final eradiction of disease. An aggressive approach to abscess management is felt to be justified in this disease entity.


Effect of Crude and Purified hCG on Lymphocyte Blastogenesis. Crude APL hCG completely inhibited blastogenesis induced by phytohemagglutinin, pokeweed mitogen, or concanavalin A in normal lymphocytes and lymphocytes obtained from cancer patients. Phenol in quantities comparable to its concentration in commercial lyophilized APL hCG also completely inhibited all three mitogenic responses. By contrast, similar doses of highly purified hCG had no inhibitory effect; higher concentrations produced only slight inhibition. Beta-hCG had a partial (less than 50%) inhibitory effect that was dose-independent and nonreproducible.


Peripheral and Ovarian Steroids in Ovarian Hyperthecosis. Serum levels of cortisol (F), pregnenolone (delta5-P), 17-hydroxypregnenolone (17-delta5-P), progesterone (P), 17-hydroxyprogesterone (17-P), androstenedione (A), testosterone (T), 5alphadihydrotestosterone (DHT), dehydroepiandrosterone (DHEA), its sulfate (DHEA-S), estrone (E1), and estradiol-17beta (E2) were measure in 2 virilized patients with ovarian hyperthecosis. Daily morning blood samples were obtained for 6 consecutive days. Dexamethasone (Dex) 2 mg/day was administered orally starting after venipuncture on the second day and continued for 5 days. Human chorionic gonadotropin (hCG) was administered intramuscularly on the afternoon of the fourth and fifth days. Following the suppression-stimulation test, both patients underwent abdominal hysterectomy and bilateral salpingo-oophorectomy. At the time of surgery, samples of peripheral and ovarian vein blood were obtained for steroid measurements. Blood samples were also obtained postsurgery to evaluate the effect of ovariectomy on the steroid levels. Of significance were the following observations: 1)Although both patients were eumenorrheic, no corpus luteum or corpus albicans was seen on histologic examination of the ovaries. 2)Of the androgens measured, only peripheral T and DHT were elevated and did not suppress on Dex treatment, but decreased to low levels following ovariectomy, pointing toward the ovary as the source of excess T and DHT. Both patients had elevated T and DHT in the ovarian vein samples. 3)In 1 patient the ovarian vein samples shoed elevated F levels with a significant ovarian-peripheral venous gradient for this steroid, and indication of ovarian secretion of F in this patient. 4)The levels of 17-P were elevated in both patients, did not suppress on Dex, and increased markedly following hCG, suggesting the ovary as the source of excess 17-P. Since A levels were normal and did not increase concomitantly with 17-P levels following hCG, it is likely that the patients had a decreased activity of the ovarian C17-20 desmolase, the enzyme responsible for the conversion of 17-P to A.


Continuous Fetal Scalp and Carotid Artery Oxygen Tension Monitoring in the Sheep. Fetal scalp and carotid PO2 were recorded continuously by polargraphic oxygen electrodes at several levels of maternal oxygenation. The results were compared to measurements obtained by intermittent blood samples using the radiometer blood gas analyzer. There was a good correlation between the PO2 values measured by the implanted oxygen electrodes and by conventional analyses of blood samples collected anaerobically. Electrode measurements differed from the control radiometer values by a mean of +/- 1.2 mmHg; 2 SD= +/- 2.50. Scalp PO2 recordings were lower but paralleled the carotid recordings under varying degrees of maternally inspired  O2 concentrations. Thus scalp PO2 levels reflect closely those in the central fetal circulation. Administration of 95% O2 to the mother resulted in a 27% increase of scalp PO2 and a 29% increase in the carotid artery PO2 when compare to room air.


The Determination of Peroxidase in Amniotic Fluid. Analyzing total peroxidase activity in amniotic fluid is extremely simple, requiring only 1 1/2 minutes of incubation at room temperature and a spectrophotometer. Peroxidase, clearly detectable at as early as 17 weeks' gestation in the amniotic fluid, increases 100-fold by term. The increase follows a predictable rising curve and can be used to estimate the fetal age. Maturation of the fetal salivary gland is most probably the source of rising amniotic fluid peroxidase levels. Samples from complicated pregnancies are lower than normal, do not increase as rapidly, and probably can be bracketed into their own ranges for gestational age evaluation.


The glucose-insulin ratio in amniotic fluid. The purpose of this study is to present evidence that the glucose-insulin ratio in amniotic fluid is a prognostic indicator of the status of the fetus in utero and of the newborn in insulin-dependent diabetic pregnant women.


Management of intrauterine fetal demise and missed abortion using prostaglandin E2 vaginal suppositories. Two hundred and twelve patients diagnosed as having a missed abortion or intrauterine fetal death were managed by the use of prostaglandin E2 vaginal suppositories. The method had a high efficacy rate with 98% of the patients experiencing successful evacuation of the uterine contents. The mean time to abortion was 10.9 hours with a mean dose of 60 mg (3 suppositories). Side effects were well tolerated. Transient pyrexia was present in 36% of the patients during therapy, but returned to pretreatment levels after abortion. No intrauterine infection was observed. The risks associated with active treatment can be avoided. The ease of administration permits initiation of therapy as soon as the diagnosis is confirmed.


Electroencephalographic changes following intraamniotic prostaglandin F2 alpha administration for therapeutic abortion. Electroencephalograms were obtained on 43 patients undergoing therapeutic second trimester abortion using intraamniotic prostaglandin F2alpha. Recordings were made before and 4 hours after prostaglandin administration, as well as 4 hours after the abortion. At 4 hours after prostaglandin administration, 30% of the women had abnormal tracings, while 50% of the women had abnormal recordings 4 hours postabortion. Although the changes consisted primarily of mild generalized or lateralized slowing, 4 patients developed paroxysmal activity not initially present. This finding would seem to suggest a potential relationship between PGF2alpha administration and clinical seizures.


Locked twins. An unusual method of delivery. This report concerns a case of locked twins encountered at the Mayo Clinic. The method of delivery is unusual, and the fact that both infants survived is also worthy of reporting.


A method of Pomeroy tubal ligation reanastomosis. A method of reanastomosis of the uterine tube after Pomeroy tubal ligation is presented. The pregnancy rate was 69%. The viable birth rate was 38%, with 1 ectopic pregnancy, 2 patients pregnant, and 1 patient lost to followup at the time of this report.


A new method to achieve complete akinesia of the facial muscles of the eyelids. Blocking the facial nerve by injecting anesthetic agent over the most posterior, most superior palpable aspect of the ramus of the mandible produces more reliably complete facial nerve akinesia than obtained by the standard techniques used to obtain facial akinesia. The position is posterior and inferior to the point chosen for the classical O'Brien block. This new technique is safe and no complications have been noted in over 10 years of use. It is highly recommended as a method of achieving total hemifacial akinesia for ophthalmic procedures.


Iridectomy in rubeosis iridis.

Iridectomy in rubeosis iridis. Creating an iridectomy in the face of rubeosis iridis carries a significant risk of hyphema. A technique is described utilizing a bipolar micro-cautery to cauterize iris vessels under direct observation before cutting iris tissue. This allows the iridectomy to be performed with less risk of intraocular bleeding.


Surgical repair of a traumatized shrunken eye. A 50-year-old Japanese man underwent removal of a traumatic cataract with an intralenticular foreign body. Surgery was complicated by an unplanned extracapsular delivery of the lens and vitreous loss. Two years later, with a visual acuity of hand motions and signs of phthisis bulbi, he had a vitrectomy that cleared the media to reveal a rhegmatogenous retinal detachment. The detachment was treated by cryopexy, scleral buckling, and intraocular gas injection. One year after this combined procedure, his best corrected visual acuity was 20/400 with clear media and attached retina.


The partial-punch: a new combined cataract-glaucoma operation. This report describes a new combined cataract extraction-glaucoma procedure. The technique is a modification of a standard filtration type of operation. The essential step is the development of a shelved posterior scleral lip, 4 mm of which is excised; full thickness sclera is not removed. This permits tight incisional closure, but with the presence of a "valve" permitting exit of aqueous under a prepared conjunctival flap should intraocular pressure rise significantly in the postoperative period. In 15 cases there were no serious complications, no flat anterior chamber, good pressure control in 14 cases, and filtering blebs in nine.


Cataract extraction in pathological myopia. Fifty-three cataract extractions in eyes with pathological myopia effected visual improvement in 47 eyes (89%). The median visual acuity increased from a preoperative level of 20/300 to 20/40 postoperatively. The incidence in this series of vitreous loss (1.9%) and retinal detachment (1.9%), are within the expected range of such complications. Four cases developed aphakic glaucoma which has necessitated continued therapy. All four had both enzyme zonulolysis and topical steroids, postoperatively. Other problems unique to surgery in these eyes are the missed diagnosis of nuclear cataract, possible dislocation of the lens, perforation of the sclera during retrobulbar injection, and rupture of the globe with vigorous digital massage.


Clinical and ultrastructural correlation in congenital and acquired ptosis. The levator superioris muscle has been studied with the light microscope and the electron microscope in congenital and acquired ptosis. Ultrastructural finding correlated closely with the clinical entities. Congenital ptosis appears to be on a myogenic basis. Acquired ptosis ultrastructurally indicates a regenerative process.


Epiphora following rhinoplasty and Caldwell-Luc procedures. Cosmetic rhinoplasty and maxillary sinus surgery are rare causes of lacrimal obstruction. The lacrimal sac is quite vulnerable to damage by the lateral osteotomy of the rhinoplasty. While obstruction from such damage usually resolves in three months, these three cases illustrate the risk of perisitent obstruction, particularly in complicated cases. The nasoantral window in the Caldwell-Luc may damage the distal lacrimal opening if it is placed too high, or made too large. Occasionally, the duct will extend more anterior and inferior and be quite vulnerable to damage by the nasal antrostomy.


Intraocular microsurgery: I. New instrumentation (SITE). The SITE instrument appears to combine advantages of other instruments previously described. It meets the proposed objectives of an efficient cutter where tissue is removed at the front end of the tip. It allows the surgeon complete control of the suction and reflux systems. The instrument is of a simple modular dsign. A fiber optic attachment is available. It is dependable and safe.


Teratogenesis.

Teratogenesis. In this presentation the scope of the problem of teratogenesis and the essentials of teratology are briefly reviewed. The teratogenicity of any compound is a reflection of a complex interaction of the compound with both the maternal and fetal tissues, the genetic background of the fetus, and the time sequence of gestational events. Under such circumstances the implication of a single compound as a teratogen is difficult, a fact reflected in the high percentage of congenital morphologic abnormalities for which no cause can be ascribed. Four compounds--thalidomide, anticonvulsants, alcohol, and folic acid antagonists--with a known teratogenetic effect on the musculoskeletal system are discussed, as is the role of the orthopedic surgeon in teratology.


Dislocation of the hip in birth defects. Several heritable disorders--although rare--are reviewed that are directly or indirectly related to dislocation of the hip. With the ever increasing list of clinical syndromes and our growing understanding of genetics, the physician who first sees these patients should broaden his views to identify these conditions and establish the diagnosis. The effectiveness of treatment often depends upon such knowledge.


Congenital deformities about the knee.

Congenital deformities about the knee. Congenital deformities about the knee are the result of abnormalities of all the anatomical structures that make up this joint. In some cases the structural changes observed are due to primary disorders of formation and growth of one or more of the anatomical components of the knee. Disorders are known to occur in the integumentary, muscular, ligamentous supporting, and skeletal systems. Examples of these disorders are seen in the bone dysplasias and joint laxity syndromes. In other cases exaggerated intrauterine positions of the limb seem to bring about certain adaptive changes in the embryological development of this joint. Epiphyseal dysplasias can lead to precocious arthropathy. Subluxation of the patella is often an indicator of a ligamentous laxity syndrome. It can also occur as a result of anatomical abnormalities of the femoral condyles or be due to congenital or acquired quadriceps fibrosis. Hypoplasia of the patella with dislocation is seen in the nail-patella syndrome.


Foot deformities.

Foot deformities. A list of syndromes that include foot deformities as part of the clinical presentation has been compiled and subdivided into a descriptive classification. A brief discussion is presented of the embryology of the foot as it pertains to and helps explain the etiology of these various anomalies. Variations in the treatment of arthrogryposis multiplex congenita and ring constrictions are described. Finally, unique foot configurations are documented, which if seen should alert the clinician to consider the diagnosis of a specific syndrome.


The radial clubhand.

The radial clubhand. Deficiency of the radial ray is both isolated and syndromatic. Before treatment is undertaken, careful consideration has to be given to the entire child. In individuals in whom treatment is indicated, a program of plasters, centralization, and prolonged intramedullary rod fixation is recommended.


Orthopedic aspects of bone dysplasias.

Orthopedic aspects of bone dysplasias. Although the number of bone dysplasias and their variable forms of expression seem to be increasing almost daily, in almost all instances orthopedic disease is detected at rather specific locations--the cervical spine, the thoracic and lumbar spine, and the knee and hips--and the orthopedic deformity is surprisingly constant.


Limb deficiencies and prosthetic devices. The child with a congenital limb deficiency is best managed by an interdisciplinary clinic team, which can see him early and work with parents and agencies to provide adequate and early prosthetic prescriptions. Terminal transverse limb deficiencies are generally fitted similarly to the patient with acquired amputation at the same level. Other deficiencies often require nonstandard prosthetic devices in association with corrective or conversion surgery.


The role of the psychiatrist in myelodysplasia. Management of the myelodysplasia patient and his family is best performed in the multidisciplinary setting of a comprehensive care clinic. Careful initial evaluation by each subspecialist on the team followed by family counseling provides the basis for selection of patients for treatment. Subsequently each subspecialist contributes up-to-date assessment and on-going medical care. Prevention of progressive orthopedic deformity through the use of plaster casts may minimize the need for surgical treatment. Severe deformities may require muscle balancing procedures. Aggressive surgical intervention is indicated in cases of progressive scoliosis and lordoscoliosis. Minimal urologic evaluation and surveillance guidelines have been developed, and prevention of irreversible renal damage is possible. Chemotherapy, adequate bladder drainage, and sophisticated techniques including sphincter and bladder electromyography and the use of artificial urinary sphincters and bladder pacemakers contribute to improved urologic management. The emotional needs of the patient and his family are complex, and support by the psychiatrist and the social worker as well as all other team members is necessary for adequate development of a well adjusted child in the face of physical handicaps.


Arthrogryposis of the upper extremity.

Arthrogryposis of the upper extremity. Patients with arthrogryposis multiplex congenita of the upper extremities can be helped a great deal by comparatively minor procedures. At the outset it is important to decide which patients can be helped and which patients cannot owing to the severity of disease or the social situation. It is also important, of course, to decide which patients do not require surgical or other methods of treatment. Once these decisions are made, one can safely begin in most patients with nonoperative measures, which consist of serial corrective cast applications starting at birth with changes every two to five days initially and then less often as the deformity is corrected. In patients who do not respond to this treatment, surgical intervention is necessary. We feel that surgery will be necessary in a great many of these patients. Surgery most often consists of soft tissue releases about the elbow, principally posterior capsulotomy, and triceps lengthening with or without tendon transfers to gain active motion. In the shoulder, surgery is rarely indicated, and when it is, this will be an osteotomy. In the wrist and hand, bone operations are almost always indicated because soft tissue procedures usually fail. These patients have two advantages in spite of their severe problems: They have normal sensation and they are usually of average or above average intelligence. Any improvement in the position of their extremities and any decrease in deformity will improve their functioning significantly.


Arthrogryposis multiplex congenita of the lower extremity: report of two siblings. The purpose of treatment of arthrogryposis of the lower extremities is to achieve a stable functional weight bearing position of the affected joints. One cannot expect to achieve normal mobility and gait unless the process is mild. Achieving a functional weight bearing position of a joint may be extremely difficult, requiring repeated surgical procedures. Maintenance of correction, although often imperfect, is vital during the growing period.


The effects of prolonged consumption of wholemeal bread upon metabolism of calcium, magnesium, zinc and phosphorus of two young American adults. The ability to adapt to a large daily intake of unleavened bread made from wheaten wholemeals of high extraction rate was examined in two young Americans who had not previously consumed fiber, phytate-, and phosphate-rich bread of this type. Adaptation was evaluated by comparing balances of zinc, calcium, magnesium, and phosphorus for a 12 day period after ten days of bread consumption with those during a similar period after 50 days and also by observing changes in blood composition during this period of bread consumption. Significantly negative balances of zinc, magnesium and phosphorus were observed in the initial period. However, all had become positive or nearly so after 50 days. By contrast, calcium balances which were also negative during the initial period remained negative at the end of the study. Plasma calcium and zinc concentrations had declined to low normal or subnormal values at this time. The failure to overcome the disturbing effects of consumption of wholemeal bread upon calcium metabolism occurred despite daily exposure to sunshine for many hours under conditions favorable for Vitamin D biosynthesis.


Advisability of surgical treatment for chronic membranous obstruction of the hepatic portion of the inferior vena cava. Transatrial membranotomy was performed in a patient with membranous obstruction of the hepatic segment of the inferior vena cava, manifesting as longstanding varicosity and edema of the legs, chronic type of Budd-Chiari syndrome, liver cirrhosis and hypersplenism. The course in this patient and similar ones reported in the literature suggests a conservative approach.


Peptic ulcer in Iranian children.

Peptic ulcer in Iranian children. Thirty cases of peptic ulcer were presented, all of which were diagnosed in accordance with strict radiological criteria. Upper abdominal pain was the most common presenting symptom. Hemorrhage occurred in 36.6% of the cases, and 16.6% suffered from melena and hematemesis requiring transfusions on admission. The only fatal case was due to perforation of a duodenal ulcer. Almost all of the children came from lower income groups and were inhabitants of Tehran or the suburbs. The incidence of peptic ulcer in Iranian children is 15.1 per ten thousand with 60% of the cases occurring in females. This suggests that peptic ulcer may be more common in Iran when compared to Europe or the United States and taht more cases occur in female children in Iran.


Effect of electrolytic lesions of the medullary inspiratory region in rats. The medulla oblongatas of 48 anesthetized rats were explored by electrical stimulation. The pneumotachogram and in some, the arterial blood pressure as well, were recorded. The inspiratory area was located in the ventral reticular formation from the obex to 1.8 mm rostral to the obex. It occupied about 2.2 mm3 on each side of the midline. The expiratory reactive points were scattered in a region which was dorsal and caudal to the inspiratory area. Unilateral and midline lesions produced by 3, 5 and 8 ma direct current did not stop rhythmic respiration. There was an initial increase in the respiratory rate followed by diminution to below that of the prelesion time. The respiratory air flow was decreased. The changes in respiratory rate and air flow were not statistically significant in majority of the above groups. Bilateral lesions produced by 3 or 5 ma stopped breathing. Continuation of thythmic respiration after destruction of a number of inspiratory neurons and/or fibers in the midline or one side of the medulla indicates that all the inspiratory neurons and fibers are not essential for the maintenance of respiration. Cessation of thythmic respiration after destruction of all or most of inspiratory neurons on both sides of the midline indicates the essential role of the medulla-oblongata for genesis or maintenance of rhythmic respiration.


Beta-adrenergic receptors and the effect of beta-adrenergic blocking agent propranolol on histamine and reserpine stimulated gastric acid secretion in man: normals and duodenal ulcer cases. The effects of the beta adrenergic stimulant drug, "Nylidrin", and the beta adrenergic blocking agent, "Propranolol", on human basal gastric acid secretion were studied in 20 healthy volunteer subjects and 10 chronic D.U. cases. Nylidrin increased gastric acid secretion and volume. All effects of nylidrin were blocked by prior administration of beta adrenergic inhibitor propranolol. Propranolol diminished both acid secretion and volume in both normal and D.U. cases. The presence of beta adrenergic receptors in the human stomach was suggested. The effects of beta adrenergic blocking agent propranolol on gastric secretion, stimulated with histamine, were studied in 10 normal subjects and 10 cases of chronic duodenal ulcer patients. Pretreatment with propranolol produced a signigicant depression of the 90 minute acid response to histamine in both volume and acidity in normals and duodenal ulcer cases. It is concluded that propranolol has an antisecretory effect, not only on basal gastric secretion but also on histamine stimulated secretion in man. Reserpine stimulated gastric acid secretion and volume in normals but showed no similar effect in D.U. cases. After pretreatment with propranolol it reduces the gastric acid secretion and volume in normals and D.U. cases.


A cervical spinal cord injury following chiropractic manipulation. A case is presented of a permanent C4 tetraplegia following chiropractic manipulation of a patient with ankylosing spondylitis. The pertinent literature is reviewed.


Urological management in onon-traumatic paraplegia: disc protrusions, multiple sclerosis and spinal metastases. The urological management in non-traumatic paraplegia differs little from the management of the traumatic case; a policy of conservative optimism is adopted, particularly in dealing with multiple sclerosis and certain malignancies.


Micturition patterns in patients paraplegic following spinal cord injury. Patterns of micturition in normal subjects and in patients after complete and incomplete injury of the spinal cord have been compared. All patients showed an abnormal flow pattern, this being least obvious in those who had undergone resection of the bladder neck and external sphincter. It is suggested that the Disa type 14 F 45 mictiograph is a useful instrument in determining the need for transurethral resection following spinal cord injury.


A further look at the rationale of 'external sphincterotomy'. A sound anatomical and physiological basis has now been provided for the endoscopic operations which are carried out for the relief of urethral obstruction due to spasticity of the external sphincter. However, the operation 'external sphincterotomy' was originally applied empirically to cases with sacral areflexia in which the mechanism of the obstruction was obscure. It now seems that plain muscle contraction under sympathetic control and influenced by posture is probably responsible and there are prospects of relief from the use of alpha-adrenergic blocking agents. When endoscopic incision is required, the operation might be better designated 'internal membranous urethrotomy'.


Modified approach to sphincterotomy in spinal cord injury patients. Indications, technique and results in 32 patients. Indications, technique and results of a modified approach to an extended sphincterotomy in spinal cord injury patients with voiding dysfunctions is presented. There were 32 patients who underwent surgery and were subjected to analysis for their dysfunctional bladder and bladder-neck problems. Overall satisfactory results were obtained in about 90 per cent patients following sphincterotomy. Early recognition of patients where intermittent catheterisation may not succeed is presented to intervene and establish an early catheter-free status in such patients. Foley indwelling catheter in ten patients, being worn from seven months to four years, where intermittent catheterisation had not succeeded elsewhere, were decatheterised following surgery. Excellent results were obtained in ten patients with vesico-urethral reflux; external sphincterotomy, therefore, seems to be the treatment of choice for complete spinal cord transection with vesico-ureteral reflux. An attempt has also been made to present physiology of micturition reflex in spinal cord injury patients.


The twelve o'clock sphincterotomy: technique, indications, results. Outflow obstruction at the level of the external sphincter in patients with neurogenic bladder dysfunction is common and transurethral sphincterotomy the treatment of choice. Based upon the anatomy of the striated muscle fibres forming the external sphincter and its blood supply, we find from our results on 35 patients, 17 of whom had a follow-up of more than three years, a transurethral sphincterotomy only in the 12 o'clock position as sufficient and preferable. The results indicate that this comparatively simple technique is effective in order to diminish outflow resistance at the level of the membranous urethra. Concerning fresh paraplegics with unbalanced reflex bladder, sphincterotomy is usually not performed earlier than one year after the injury.


Late results of bilateral endoscopic sphincterotomy in patients with upper motor neurone lesions. Most authors presently agree that in motor neurone lesions sphincterotomy provides a reliable means of alleviating chronic retention due to detrusor-sphincter dysfunction. But, although early results may be very encouraging, one should consider that some patients are prone to fibro-sclerotic restenosis. Regular annual check-ups are therefore essential in order to avoid relevant complications.


Pathology of the striated urethral sphincter in spinal cord injury patients: indications and results of external sphincterotomy (100 cases). Up to date, we have carried out 100 external sphincterotomies, of which 65 only concerned traumatic spinal cord injuries.


Differential diagnosis and limitations of external sphincterotomy. A study of 1000 neurologic bladders has shown us that a well-balanced working of the bladder must be keenly searched for, and that sphincterotomy must be early indicated, and even performed several times if necessary. So 100 sphincterotomies performed on male patients, out of 730 cases, have shown us that their one-and-only risk, incontinence, depended chiefly of the condition of the detrusor, therefore on the short or long evolution of the sclerosis of the external sphincter, which is only one out of all the possible impediments.


The effect of trans-urethral surgery on penile erections in spinal cord injury patients. The effect of transurethral surgery on penile erections in 62 spinal cord injury patients is reviewed. In a group of 43 patients with preoperative erections, 19 noticed no change in the pattern of erections. Twenty-four of the 43 patients notice either a diminution or total disappearance.


Impairment of erection after external sphincter resection. Two cases of temporary loss of reflex erectile activity after transurethral bladder-neck and external sphincter resection are reported in two tetraplegics. Only recently such occurrences have been reported in the literature associated with external sphincterotomy. The reasons are discussed and most likely direct damage to erectile tissues is the cause of such a complication.


Experiments with defined multispecific coccidial infections in lambs. The behaviour of four species of Eimeria was studied in lambs which were given either monospecific or multispecific infections. In the presence of other species the patency of oocyst production of E. ovina and E. weybridgensis was extended and the total number of oocysts produced by all species except E. ninakohlyakimovae was increased. Clinical symptoms were observed only in lambs which received E. ninakohlyakimovae.


A study on snail location by Fasciola hepatica using radioisotopically labelled miracidia. A number of common freshwater molluscs were exposed to Fasciola hepatica miracidia labelled in vivo with radioselenium. Radioactivity was rapidly incorporated in all lymnaeid species tested (L. stagnalis, L. tomentosa and L. truncatula) whereas no radioactivity could be demonstrated in non-lymnaeid pulmonate species (Aplexa hypnorum, Physa acuta, Physa fontinalis, Anisus vortex, Gyraulus albus and Planorbis planorbis) or in the prosobranchs Valvata cristata and Valvata piscinalis. However, the prosobranchs Bithynia leachii, Bithynia tentaculata and Potamopyrgus jenkinsi showed a slow but significant uptake of radioactivity which was presumably explained by uptake of labelled miracidia through a 'filter-feeding' mechanism. Sphaerium corneum, a true filter-feeder, showed a similar course of uptake of radioactivity.


Immunity to primary and challenge infections of Trichinella spiralis in mice: a re-examination of conventional parameters. In young (6- to 8-week-old) NIH strain inbred mice expulsion of a primary infection of Trichinella spiralis began on day 8 and was virtually complete by day 11-5. In older mice expulsion occurred 1 or 2 days earlier. Experience of a primary infection elicited strong immunity to challenge, whether the challenge was given immediately after worm expulsion (day 14) or delayed (day 42). Challenge infections were expelled rapidly the majority of worms being lost during the first day. Immunity to challenge was elicited by low-level primary infections and was effective against large ventionally accepted parameters of immunity to T. spiralis in mice which, it is considered, are applicable only to mice with a genetically determined low-level of responsiveness to the parasite.


A genetic investigation of virulence in a rodent malaria parasite. The genetic basis of virulence in a line (YM) of Plasmodium yoelii yoelii was investigated in a cross with a mild line (A/C). The blood forms of the virulent line developed extensively in mature erythrocytes of mice, causing death of the host within 7 days; infections with the mild line were normally restricted to reticulocytes, infected animals recovering after three weeks. Lines YM and A/C differed additionally in enzyme and drug-sensitivity markers. Studies on infections established from each line alone from sporozoite mixtures of the two lines and from the cross between the lines showed that the appearance of virulence had been caused by a genetic change in the parasite, and not by other factors such as a concurrent infection with another organism. An analysis of the characters of 56 clones derived from the cross showed that the virulence character had undergone recombination with the other markers, and appeared to be inherited in Mendelian fashion. Three clones exhibited atypical virulence, although it was not clear whether this had been produced by genetic recombination.


The sites occupied by the acanthocephalan Pomphorhynchus laevis in the alimentary canal of fish. The distribution of the acanthocephalan Pomphorhynchus laevis along the alimentary tract of several species of freshwaster fish was studied in both natural and experimental infections. The parasite exhibits a clear preference for a particular region of the alimentary canal, which differs from host species to host species, but it is capable of surviving in all regions of the intestine. In some species, but not in all, its growth rate may be reduced in regions outside of the preferred site. The parsite remains in the same site throughout the period of infection, emigrations occurring only preparatory to complete loss of the parasite from the host. The presence of cestodes in the region of the preferred site has no effect upon the distribution of the parasite. At high levels of infection the range of the parsite's distribution is extended. The feeding of larval parasites to fish by stomach tube also leads to an extension of range, whereas when fish are allowed to feed on cystacanths removed from their intermediate host the parasite establishes in a more anterior position than usual and in a site that it does not occupy to any extent in natural infections. It is concluded that the distribution of P. laevis in the alimentary canal of fish is determined primarily by the process of liberation, activation and establishment of the parasite, and that it normally attaches in the first available space and remains there. Unsuitable physico-chemical or feeding conditions affect only its growth, not the site that it occupies. It is suggested that P. laevis may be atypical in this respect.


Considerations in management of the child with cerebral palsy. Throughout this article, the reader will recognize that the term "management" rather than "treatment" has been used when referring to the child with cerebral palsy. Treatment implies a reasonable chance for cure, something that is currently impossible in cerebral palsy. "Management" is a more honest term, implying consideration of all of the problems of the child with cerebral palsy and his family and bringing to bear those elements of decision making that lead to maximal benefit to the patient.


Primary recognition and treatment of congenital dislocation of the hip. The pathology associated with congenital dislocation of the hip has been reviewed. The pathophysiology as it affects the development of the hip under treatment makes a strong case for the avoidance of the "frog leg" position with fixed flexion and abduction of the hips in the plaster cast. It is apparent that tightness of the iliopsoas muscle and the underlying capsule makes that flexed abduction position necessary to hold the hip in position. The "frog leg" position is seriously implicated in the development of aseptic necrosis, not only of the dislocated hip but of the normal hip as well. The results seen in patients with surgical division of the iliopsoas tendon and capsular contracture, followed by leg immobilization in a functional position of extension at the hip accompanied by slight abduction and internal rotation, indicate the virtual elimination of the necessity for secondary reconstruction procedures on the hip at a later date. This appears to be the more conservative approach to treatment in children under age two. A period of one to three months in a splint that flexes and abducts the leg but permits changing positons may be tried before the obstruction is relieved. For children with lax capsule and iliopsoas, reduction may be possible by this route. For most the hip will be pressed in slightly improving the x-ray picture--but with the obstruction still before the femoral head. The seating of the femoral head must be exact. If it is not, imperfection in the development of the hip arises and may lead to later malfunction. Obstructions to perfect seating of the femoral head in the acetabulum must be overcome.


Diagnosis and management of torticollis. Clearly, torticollis may stem from a variety of factors involving a number of primary structures -- bones, ligaments, muscles, and the nervous system. The crucial point is to differentiate torticollis that may lead to structural changes from that of a compensatory or functional nature. The key criterion is whether torticollis persists or resolves. This can be readily determined by treating torticollis initially with head halter traction of three to four pounds' weight and observing whether it resolves in five of seven days. If the torticollis and related symptoms persist beyond this time, the physician should consider possible lesions other than common rotary subluxation. Diagnosis of unresolved torticollis requires extensive and often repetitive investigation procedures. Perseverance in the diagnosis and management of persistent torticollis is a commendable virtue.


Childhood foot and leg problems.

Childhood foot and leg problems. A thorough history and examination are essential to the accurate diagnosis of foot and leg problems in children. Most such problems, if diagnosed and treated early, can be corrected by conservative measures. Footwear for these children must be properly chosen.


Orthopedic overview of juvenile rheumatoid arthritis. Juvenile rheumatoid arthritis can be classified into three forms by the extent of early involvement: (1) pauciarticular, (2) polyarticular, and (3) systemic. When this disease, in which remission is common, is properly diagnosed and appropriately treated by physical therapy, occupational therapy, drug therapy, and surgical treatment, a good clinical result can usually be expected. Only 16 of 124 children had severe persistent impairment because of the disease in one recent study;18 this number may be high, since mild cases may be unrecognized or not be referred to the study clinic. However, efforts should be directed to reducing this number of severely impaired children -- in the short run by better techniques of reconstructive surgery and in the long run by a better understanding, through research into the etiology and pathogenesis of the disease adequate to prevent or significantly alter its course. The disease may be caused by a treatable occult infective agent and may respond to an approach similar to that for rheumatic fever, which no longer fills the wards of our children's hospitals as it once did.


The effect of age, sex, race, and economic status on dental caries experience of the permanent dentition. Committee to Review the Ten-State Nutrition Survey of 1968-1970. The Ten-State Nutrition  Survey data show a consistent, dramatic, and meaningful difference in dental caries experience between black and white children at all ages. This difference transcends socioeconomic grouping, nutritional level, and developmental status. This study also has shown an apparently protective effect of poverty insofar as dental caries is concerned. Children from lower-income families experienced less dental caries than children from higher-income families.


Birthweight doubling time: a fresh look. Infant birthweight doubling time is widely quoted as being achieved between 5 and 6 months. The purpose of this study was to determine the time of birthweight doubling and to identify important related variables. A total of 357 normal infants with birthweights between 2,500 and 4,100 gm were studied. Mean age of birthweight doubling for the entire group was 119 days (3.8 months). Bottle-fed infants doubled their birthweights earlier than breast-fed infants: 113 days vs. 124 days (P less than .05). Boys doubled their birthweights earlier than girls: 111 days vs. 129 days (P less than .0001). Solids were introduced earlier in bottle-fed infants (mean , 1.9 months) than in breast-fed infants (mean, 3.9 months). Harvard percentiles for mean group weight and length at the time of birthweight doubling were: for bottle-fed infants, 75th and 55th percentiles respectively: for breast-fed infants, 55th and 60th percentiles respectively; for boys, 75th percentile for both weight and length; for girls, 50th percentile for both weight and length. Thus, bottle-fed infants appear to have weight gains in excess of length gain and may be developing early obesity. In light of the poor prognosis in treating obesity, closer supervision of early infant feeding practices is indicated.


A therapeutic trial of fatty acid supplementation in cystic fibrosis. Seven children with cystic fibrosis (CF) have been treated for at least one year with intravenously administered soya oil emulsion. In all, an improvement of at least one biochemical abnormality in character with the disease appeared. The children's clinical course remains benign. This course is remarkably better than that of other children with CF treated without Intralipid in Auckland in the same period, though a placebo effect cannot be discounted. It is postulated that intravenous supplementation with essential fatty acid in CF may in turn partially correct an error of metabolism of prostaglandins present in the disease.