The expression and localization of surface neoantigens in transformed and untransformed cultured cells infected with avian tumor viruses. The presence and localization of neoantigens induced in cultured cells, infected or transformed with avian tumor viruses (ATV), were studied ultrastructurally on carbon platinum replicas of cell surfaces. The use of antibody, labeled with hemocyanin molecules, provided sensitive detection and analysis of cell surface antigen distribution. The subgroup-specific antigens of the viral envelope were found in considerable amount in the plasma membranes of ATV-infected chick embryo fibroblasts. The distribution of these antigens over the cell surface, evaluated on cells which were prefixed with glutaraldehyde, was found to be diffuse with a  greater density on the cell processes in some cells. Reaction of antibody to viral envelope antigens with living ATV-infected cells resulted in a number of patterns of redistribution of membrane antigen-antibody complexes (AAC). Redistribution occurred in symmetrical or asymmetrical modes. The former consisted of randomly oriented aggregates (patches) of AAC over the cell surface. The latter included: (a) linear accumulation of AAC at cell margins; and (b) condensation of compexes into one or more centers of coalescence. These observations could be made on chick embryo cells infected (but not transformed) by avian leukosis virus, or on cells oncogenically transformed by avian sarcoma virus. The regions of coalescence were suggestive of the "capping" phenomenon seen in other systems, and their formation was temporally correlated with endocytosis of labeled AAC and the gradual loss of AAC from the surface. The effects of several biologically perturbing substances on the processes of redistribution were investigated in ALV-infected fibroblasts. Sodium azide, puromycin, actinomycin D, and colchicine had no effect on either form of asymmetrical redistribution. Cytochalasin B (CB) and iodoacetic acid (IAA) appeared to have some effect on the marginal redistribution, and to completely prevent the condensation into foci of coalescence (FC). When treated with these compounds, reacted with antibody at low temperature, washed free of unbound antibody, and warmed at 37 degrees C, cells rapidly cleared their surfaces of AAC. This was not accompanied by formation of FC or endocytosis. In some of these cells, a distribution was observed which suggested a possible centrifugal flow of antigenic sites-perhaps an alternate route for disposal of AAC. None of the drugs tested affected symmetrical redistribution. Repeated attempts at detection and topographical analysis of a tumor-specific antigen on the surface of Rous sarcoma virus-transformed chicken and rat cells have provided no evidence for antibody to such an antigen in the serum of immunized animals. Autochthonous, homologous, and heterologous immunizations of chickens and rats did not produce a detectable antibody response to a virus-specific tumor surface antigen. Preliminary results, however, suggest the expression of an individual-specific (unique) tumor antigen on the surface of Rous sarcoma cells.


The size of adenylate cyclase and guanylate cyclase from the rat renal medulla. The size distribution of adenylate cyclase from the rat renal medulla solubilized with the nonionic detergents Triton X-100 and Lubrol PX was determined by gel filtration and by centrifugation in sucrose density gradients made up in H2O or D2O. The physical parameters of the predominant form in Triton X-100 are s20,w, 5.9S; Strokes radius, 62 A; partial specific volume (v), 0.74 ml/g; mass, 159,000 daltons; f/f0, 1.6; axial ratio (prolate ellipsoid), 11. For the minor form the values are: s20w, 3.0; Stokes radius, 28 A; mass, 38,000 daltons; f/f0, 1.2. The corresponding values determined in Lubrol PX are similar. The value for V for the enzyme indicates that it binds less than 0.2 mg detergent/mg protein. Since interactions with detergents probably substitute for interactions with lipids and hydrophobic amino acid side chains, these findings suggest that no more than 5% of the surface of adenylate cyclase is involved in hydrophobic interactions with other membrane components. Thus, most of the mass of the enzyme is not deeply embedded in the lipid bilayer of the plasma membrane. Similar studies have been performed on the soluble guanylate cyclase of the rat renal medulla. In the absence of detergent, the molecular properties of this enzyme are: s20w, 6.3S; Stokes radius, 54 A, V, 0.75 ml/g; mass, 154,000 daltons f/f0, 1.4; Axial ratio, 7. The addition of 0.1% Lubrol PX to this soluble enzyme increases it activity two- to fourfold and changes the physical properties to: s20,w, 5.5S; Stokes radius, 62 A; V, 0.74 ml/g; mass, 148,000 daltons, f/f0, 1.6; axial ratio, 11. These results show that Lubrol PX activates the enzyme by causing a conformational change with unfolding on the polypeptide chain. Guanylate cyclase from the particulate cell fraction can be solubilized with Lubrol PX but has properties quite different from those of the enzyme in the soluble cell fraction. It is a heterogeneous aggregate with s20,w, 10S; Stokes radius, 65 A; mass about 300,000 daltons. The conditions which solubilize guanylate cyclase also solubilize adenylate cyclase and the two activities can be separated on the same sucrose gradient.


Occupational therapy treatment of the patient with thermally injured upper extremity. Severe upper extremity burns may mean an indefinite interruption in the style of life to which an individual is accustomed, and the occupational therapist can help the thermally injured patient to regain purposeful activity. Even a simple temporary prosthesis for the amputee, enabling him to write (Fig. 12-17), permits meaningful activity that can reduce boredom, dependence, preoccupation with death, and depression. A vigorous progressive physical and occupational therapy program producing tangible results does more for the patient's morale than any verbal encouragement could possibly do. Finally, the therapist can be more than the "mechanic" of the burn team. In his daily contact with the patient, he can be a "good listener" to whom the patient can verbalize his hostility, anger, resentment, and fear. When appropriate, he may convey this information to the physician, who can help the patient gain insight into some of the problems manifested by his behavior.


Electrical injuries of the upper extremity. Although electrical burns of the upper extremity comprise a small percentage of all thermal injuries, they present formidable clinical problems. The physician must not be lulled into a false sense of security because the visible cutaneous burn is not great. Sound surgical principles, such as the control of bacterial proliferation with topical chemotherapy, débridement of dead tissue, and timely wound closure, in conjunction with the expertise necessary in caring for thermally injured patients, are necessary for a maximally rehabilitated patient.


Cold injuries.

Cold injuries. The management of patients with cold injuries of the hands may be extremely simple or relatively complex. The extent of the injury and the systemic response to the cold are the major influencing factors. In patients with extensive cold injuries, where all or a large portion of more than one extremity is cold or frozen and there has been a significant systemic response, treatment should be both systemic and local. Treatment should be directed toward both the preservation of tissue and maintenance of function of the damaged part. Minimal daily débridement and late amputation are important guidelines for care.


The utilization of echocardiography in the differential diagnosis of cyanosis in the neonate. Echocardiography is a useful and reliable tool for the clinical assessment of the cyanotic neonate. It can be applied rapidly without compromising even the critically ill neonate. Hypoplastic left and right heart syndromes can be diagnosed or excluded echocardiographically. The diagnostic exclusions of total anomalous pulmonary venous drainage and complete transposition of the great arteries in the neonate with cyanosis remain difficult challenges for the echocardiographer because of the variability of their anatomic and hemodynamic presentations.


The pathogenesis and management of massive pulmonary hemorrhage in the neonate. Case report of a normal survivor. A 1,760-G MALE INFANT SURVIVED MASSIVE PUlmonary hemorrhage. The literature is reviewed and the pathophysiologic changes and pathologic findings of this usually lethal complication of prematurity are discussed. Aggressive pulmonary toilet and ventilation seems warranted for these infants.


Clinical observations on thyrotoxicosis coexisting with myotonic dystrophy. Two cases are presented and a third is cited from the literature in which the onset of hyperthyroidism exacerbated acute weakness in previously undiagnosed myotonic dystrophy. In two of the cases a return to the euthyroid state after treatment was associated with marked clinical improvement in muscle weakness. In the third case, severe bulbar and respiratory muscle weakness, which was apparently aggravated by the thyrotoxicosis, was followed by aspiration pneumonitis and death. Possible mechanisms for the effect of excessive thyroxine on muscle function are reviewed. Early diagnosis and aggressive treatment of the hyperthyroidism is extremely important.


Chronic arterial insufficiency of the upper extremity. When claudication or distal ischemia is significant, the treatment of choice for intrinsic arterial insufficiency of the upper extremity caused by atherosclerotic occlusive disease of the subclavian, axillary, or brachial artery with patent distal circulation is direct arterial surgery. Both endarterectomy and bypass procedures are utilized. In the 20 years from 1947 to 1967, 15 patients were operated on for such lesions and adequate circulation was restored in 12 patients treated by the direct method. Nine patients available for 1-year follow-up were cured of their symptoms; of the remaining three patients, one had amputation of an arm and two had sympathectomy with improvement. No hospital death occurred and morbidity was minimal. Although the diagnosis can be established on clinical grounds, arteriography is essential to ascertain the surgical procedure needed. Peripheral diseases involving the small arteries are clinically a more common cause of arterial insufficiency in the upper extremity; progress is slow and complications are infrequent. When ischemic complications exist, direct arterial surgery is not feasible and cervicodorsal sympathectomy is the usual form of treatment. Of 76 patients operated on for such disease, 74 underwent sympathetic neurectomy. The results were excellent, good, or satisfactory in 50 (78%) of the 64 traced patients. The remaining 14 patients had persistent or recurrent symptoms after operation. Removal of the stellate ganglion in addition to the second ganglion yielded better results and is indicated in recurrent or more cases.


The effect of prepaid group practice on physicians' utilization behavior. The study is concerned with the practice of physicians in a prepaid group practice setting. Specifically, it is concerned 1) with investigating the extent of variation in physician behavior concerning use of clinical resources, that is, office visits and telephone calls, and technical resources, that is, x-rays and laboratory procedures, and 2) with determining the factors that account for such variation. The universe of this study consists of all internists practicing in 1970 in the prepaid group setting of Kaiser Permanente at Portland, Oregon, a total of 34. The overall framework for the study is based on the belief that medical training and the setting in which physicians work are significant determinants of their use of clinical and technical resources in different disease situations. Specifically, the framework posits that different sets of organizational variables are important in determining use of resources for acute and undiagnosed conditions. The findings reported in the study suggest that while the teaching environment in which a physician is trained is important in shaping his clinical personality, the setting in which he actually works contains its own source of influence over his professional activity. These results also provide supportive evidence for the widely held notion that prepaid group practice, through changing the nature of the incentives to physicians and introducing professional regulation, leads to a more efficient way of providing medical care by reducing the use of costly resources.


The clinical trial as a means for organizational change: report of a case study. An attempt was made to introduce an innovation (nurse practitioners) into an organization (an outpatient clinic) using the format of a clinical trial. Staff physicians evaluated patients as to their acceptability for care by nurse practitioners before and after a 12-month trial. "Acceptable" patients were randomly assigned to control (regular clinic) and experimental groups (nurse practitioner care). There was a statistically significant increase (p less than 0.001) in physicians' willingness to delegate patients to nurse practitioners for care after the trial. Initial assessments of "acceptable" were highly associated with demographic variables such as age, race, and level of education. Patients' medical status, rather than personal characteristics, were found to be associated with decision making on re-evaluation. Positions were created for nurse practitioners on the staff of the clinic at the end of the experiment.


The Sickness Impact Profile: reliability of a health status measure. This report describes the results of research conducted on the reliability of the Sickness Impact Profile (SIP). The SIP is a questionnaire instrument designed to measure sickness-related behavioral dysfunction and is being developed for use as an outcome measure in the evaluation of health care. The test-retest reliability of the SIP in terms of several reliability measures was investigated using different interviewers, forms, administration procedures, and a variety of subjects who differed in terms of type and severity of dysfunction. The results provided evidence for the feasibility of collecting reliable data using the SIP under these various conditions. In addition, subject variability in relation to reliability is discussed.


Drug information for prescribers and dispensers: toward a model system. Four alternative ways of providing health care professionals with drug information are examined in terms of medical and social values. It is assumed that maximum patient benefit will result when prescribing decisions can be made in an environment of enlightened neutrality. The alternative of maintaining the status quo is discarded because it does little to provide practitioners with complete data. The second alternative notes major reforms that would further regulate promotional efforts and upgrade the qualifications of detailmen. Because this approach yields a suboptimum solution, a third alternative introduces the concept of a National Drug Education Foundation. This countervailing force would disseminate objective drug information to clinicians through 2,000 therapeutic consultants, subsidize professional journals and schools, develop regional drug information centers, and  conduct a variety of related functions. Foundation operations are estimated to cost $167 million per year or about one-seventh of current expenditures for drug promotion and information. Since commercial inputs would not only be redundant but also tend to negate Foundation efforts, the fourth model contends that social benefits can be optimized only when such outlays are terminated.


Continuing education activities of physicians in solo and group practice: report on a pilot study. Group practice has often been suggested as a form of medical care organization that facilitates professional pursuits, including continuing medical education. A survey was conducted among Iowa physicians in fee-for service multispecialty group practice and in other forms of fee-for-service medical practice, including solo practice and small partnerships to determine their levels of engagement in a number of different types of continuing medical education activities. While several differences between the two groups were found, the survey indicated that overall the levels of engagement for the two groups were similar.


Evaluation of a cardiopulmonary resuscitation course for secondary schools retention study. A retention study was implemented in Marshfield, Massachusetts in May 1974 in order to ascertain if cardiopulmonary resuscitation (CPR) skills could be retained by secondary school students who had 15 months previously received training in mouth to mouth resuscitation and cardiac compression. The retention study also addressed itself to the question whether a 28-minute "refresher" film on CPR skills prior to the test would serve to improve performance of CPR skills. (In the initial study, the students had been divided into two groups: those that received both didactic and practice sessions and those who received didactic training only.) All the initial practice group students (178 students who had received both didactic and practical CPR training) were divided equally into "film" and "no film" groups. A small sample of students (38) who had initially learned CPR skills from didactic materials only were also tested. These students were also divided into "film" and "no film" groups. Retention of continuous CPR skills, breaths anc compressions, showed very little loss. Retention of discrete CPR skills which included checking for breathing, opening the airway by tilting the head and lifting the neck, giving three quick breaths, feeling the pulse, and examining the pupil showed considerable loss of learning overtime. The film intervention did little to improve performance of CPR skills. No significant differences in performance were observed between "film" and "no film" groups. The findings of this study with respect to retention of continuous and discrete psychomotor sills closely parallel findings of the three-month retention study. In summary, this study would indicate that training of secondary students in CPR leads to good retention of essential skills. As indicated in the previous study, retention of the ancillary decision-making skills was not satisfactory. Methods for teaching these skills so that they will be retained over time need further development.


The role of new health practitioners in a prepaid group practice: changes in the distribution of ambulatory care between physician and nonphysician providers of care. Changes in the distribution of ambulatory care between physicians and new health practitioners (NHP) are examined in the pediatric and adult medicine departments of a prepaid group practice program. The study covers a three-year period during which NHP were extensively introduced to provide a broad range of ambulatory care. The source of data is a routine data information system that utilizes an encounter form to capture a minimal data set on every patient visit, including the provider's statement of diagnosis. Based on these data, changes in staffing are related to changes in workload and content of practice of both physicians and NHP.


Electrophysiologic properties of antidysrhythmic drugs as a rational basis for therapy. The often emergent nature of life-threatening cardiac dysrhythmias, the frequent seeming "resistance" of the abnormal heart rhythm to therapy, and the commonly encountered toxicity of antidysrhythmic agents combine to make treatment of cardiac dysrhythmias one of the strictest challenges to the practicing physician. Although electrophysiologic studies have markedly increased out understanding of dysrhythmogenesis and the actions of anti-dysrhythmic drugs, these numerous investigations have provided but little assistance to the practicing physician either as an intellectual framework or as a guide to patient care. The electrophysiologic classification of the antidysrhythmic drugs presented in this paper should be acceptable both to the electrophysiologist and the clinician since it is based on alterations in basic membrane properties and correlates well with clinical realities. It serves as a guide to initial drug selection, anticipated bioelectric complications, the use of alternative drugs, and combination antidysrhythmic therapy.


A rapid response system for out-of-hospital cardiac emergencies. We have reviewed several aspects of our initial 5 years' experience with an out-of-hospital emergency medical care system. This system is stratified and provides for rapid primary response and, when indicated, secondary response by specially trained paramedical personnel. Patient care is physician-supervised and closely monitored. Although considerable attention has been directed to acute complications of ischemic heart disease, particularly the problem of sudden cardiac death, the system is broadly based and responds to all medical emergencies. We are impressed with the ability of nonphysicians to acquire certain medical skills and judgment. Indeed, the effectiveness of this system is largely dependent on paramedical personnel. Such systems of prehospital emergency medical care will probably have an impact greater than that of hospital coronary care units in reducing the mortality from ischemic heart disease.


Tachycardias and electrical pacing.

Tachycardias and electrical pacing. Techniques of electrical pacing for the treatment of tachycardias are multiple. The choice of a suitable method for a particular tachycardia depends upon understanding the mechanism of the tachycardia and the pacing characteristics that will lead to interruption or suppression of the tachycardia, or to ventricular slowing. Electrical pacing is indicated for tachycardias when drug therapy alone has failed or cannot be initiated or continued, and only for those tachycardias that are likely to respond to this type of electrical stimulation. In either the circus movement type or the ectopic pacemaker type an ectopic tachycardia is more likely to be suppressed if the pacing site is near the site of origin of the tachycardia. Pacing more rapidly than the basic rate in order to prevent or abolish tachycardias is termed overdrive suppression. The mechanisms responsible for this phenomenon may be associated with release of acetylcholine, release of potassium, activation of an electrogenic sodium pump, increase in cardiac output and coronary flow, decrease in size of the heart with a consequent decrease in wall tension, and decrease in the inhomogeneity of recovery of excitability that occurs at more rapid rates in the non-ischemic heart. All of these effects of pacing suppress accelerated pacemaker activity or prevent emergence of conditions favorable for development of circus movement tachycardias. Paired, coupled, or rapid atrial pacing may improve ventricular performance or slow ventricular rate, or both, without abolishing the ectopic pacemaker activity. Atrial pacing with pacing sites located at endocardial, epicardial, coronary sinus, trans-septal, or esophageal locations may interrupt or prevent rapid supraventricular or ventricular arrhythmias. Similarly, ventricular pacing at endocardial, epicardial, myocardial, or transthoracic sites may be equally effective. Artificial pacing has abolished almost every type of tachycardia. Ventricular fibrillation always, and atrial fibrillation usually, require countershock if electrical treatment is to be employed, although defibrillation of the atria by rapid pacing has been reported once. Unipolar or bipolar pacemakers may be used temporarily, or permanently after implantation. Pacing rates used to abolish supraventricular tachycardias range from single premature beats to alternating current atrial pacing at 3600 cycles per minute. Artificial electrical stimulation of the heart may be on demand, or may be competitive (fixed rate). External magnets, induction coil coupling, and radio frequency signals allow competitive pacing to be used intermittently, with permanently implanted pacemakers. Thus, electrical pacing of the heart is a technique of major importance for the control of rapid heart rates.


Symposium: management of tumors of the parotid gland. The successful management of swellings in the parotid gland region is dependent upon the establishment of a clinical and/or histologic diagnosis of the condition responsible for the production of the abnormal swelling. All mobile parotid tumors are removed as an excisional biopsy with preservation of the facial nerve. A preoperative biopsy will not influence the subsequent management of these lesions. An aspiration biopsy is employed to evaluate all primary, previously undiagnosed, non-ulcerative parotid tumors suspected of being clinically malignant. An experienced pathologist views with confidence evaluation of solid material that has been carefully separated from the aspirated specimen. It is our opinion that when the biopsy tract is removed with the tumor, there is less risk of surgical wound contamination by tumor than when there is an incisional biopsy or incomplete excision of the tumor for frozen or permanent section diagnosis. One should not expect to derive as much information from an aspiration biopsy as may be derived from a formal incisional biopsy. If the histologic interpretation of the aspirated material is inconclusive, one may proceed to accept the added risk of an open biopsy. If it is known preoperatively that the tumor is malignant, that it is other than a low grade cancer, and that the tumor should be treated surgically, management of the facial nerve and the cervical nodes may be anticipated. This may be accomplished by an aspiration biopsy.


Symposium: management of tumors of the parotid gland. III. Management of the facial nerve. The facial nerve is protected in parotid surgery by finding the main trunk first and peripherally dissecting free the branches. The most constant landmark is the groove between the mastoid and the bony ear canal. Wide exposure of this groove should be obtained without "tunnelling." The thick (2-3 mm) white trunk is dissected forward using the electric stimulator before cutting parotid tissue. Nerve injury is more common in the peripheral branches. Nerve location in recurrent parotid tumors is more difficult. The main trunk may be found more posteriorly than in the previous surgery, but often peripheral branches must be identified crossing the masseter, facial vessels, or the parotid duct; retrograde dissection to the trunk follows. For proven invading malignancy, the trunk or branches may be sacrificed, but immediate grafting should be attempted usually with the greater auricular nerve.


Surgical elimination of drooling.

Surgical elimination of drooling. Drooling involves great practical problems in the care of patients with cerebral paralysis and mental deficiency. Different types of medical and surgical treatments have been used. In 17 disabled patients chorda tympani has been cut bilaterally in order to reduce the production of saliva, especially from the submandibular and sublingual glands. The loss of taste on the anterior part of the tongue seems to contribute to the reduction of salivation. Fifteen patients have been observed postoperatively during two to four years. Five patients have been cured, two are considerably improved and seven partially improved. The effect of nerve section was illustrated by Tcm99 scintigraphy in two additional cases before operation and six months postoperatively. No complications were observed.


Fibrosarcoma of the head and neck in children. A retrospective study of 11 children with fibrosarcoma of the head and neck is presented. Six of these tumors are well differentiated, and three are poorly differentiated. Nine patients were followed for over six years and are available for treatment evaluation. The results of treatment indicate that patients with superficially located, well differentiated tumors occurring at sites where wide surgical margins can be obtained have the most favorable prognosis.


Construction of a practical and inexpensive air stimulator for caloric vestibular testing. An inexpensive and practical method for delivering air into the aural canal at a selected stable temperature is described. A water-air heat exchanger utilizing the external circulation of a constant-temperature water bath brings the temperature of the air stream to a chosen value. Measurements indicate stable air outflow temperatures are maintained when proper nozzle design and air flow rates are employed. The apparatus is easy to construct and has proven convenient and effective when used in the clinical vestibular laboratory.


Effects of anoxia and ethacrynic acid upon ampullar endolymphatic potential and upon high energy phosphates in ampullar wall. The ampullar endolymphatic potential (AEP) was studied in the guinea pig during ischemia and asphyxia and following systemic application of ethacrynic acid. In addition the specialized and nonspecialized portions of the ampullar wall were analyzed for ATP and P-creatine at different conditions of metabolic interference. Under control conditions the AEP amounted to + 4.6 +/- 1.2 mV. In both types of hypoxia the decline of the AEP proceeded on a much slower time scale than that of the cochlear endolymphatic potential (CEP), and the maximum negativity reached was considerably less. Quantitative analysis of both types of ampullar wall tissue indicated a much slower decline in hypoxia of ATP levels than in the stria vascularis. Changes in P-creatine levels were considerably more rapid. The AEP became reduced and changed polarity also by intoxication with ethacrynic acid (EA), but higher dosages (above 70 mg/kg) were necessary than for effects upon the CEP and much longer time periods were required for attainment of maximum negativity. The maximum negativity of the AEP was significantly greater at a dosage of 100 mg/kg of EA than during ischemia. At the point of maximum depression of the AEP P-creatine levels in both types of ampullar tissue were unchanged, but ATP levels were significantly reduced in the specialized portions of ampullar wall.


Mondini defect in association with multiple congenital anomalies. A case of bilaterally symmetrical genetic aplasia conforming to Mondini type of congenital deformity in a 12-day-old child is presented with the help of temporal bone sections. Cochlear changes include a stunted modiolus, deficient interscalar septum between the middle and upper coils forming a scala communis cochleae, a degenerated organ of Corti and reduced spiral ganglion cells and dendrites. The vestibule is malformed, with membranous labyrinth being deficient. The utricle and semicircular canals are absent. There is no oval window or stapedial footplate, and the facial nerve is hypoplastic. An interesting feature is the unusual association of bilateral bony choanal atresia, atrial septal defect, cleft lip, absence of olfactory bulbs in the brain, and congenital ophthalmic anomalies.


Symposium: management of tumors of the parotid gland. II. Diagnosis of parotid gland swelling. Diagnosis of parotid gland swellings can be approached by attempting to answer the following questions: 1. Is it parotid? 2. Is it inflammatory or neoplastic? 3. If it is neoplastic, is it benign or malignant? Diagnosis is made by following the classical physical diagnostic procedures of inspection, palpation, and auscultation. These are followed by radiographic procedures, such as plain films, sialography and technetium scanning. Since approximately one in four parotid neoplasms is malignant, a definitive step should be biopsy. Excisional biopsy is recommended.


Symposium: management of tumors of the parotid gland. IV. Differential diagnosis and management of deep lobe parotid tumors. The problem of the pathological anatomy, the diagnosis, differential diagnosis and management of tumors of the parapharyngeal space has been discussed. Preoperative biopsy is to be discouraged in all benign lesions of the area. External approach with good adequate exposure is most important. Surgery is the treatment of choice in the benign lesion, by far the most common tumor as reported in the literature. Any tumor or disease of the superficial parotid may also be found in the deep lobe.


Symposium: the supra-tip in rhinoplasty: a dilemma. I. Theories and causes of supra-tip convexities. Supratip convexities following rhinoplasty present a challenge to the surgeon. The correct diagnosis as to cause is necessary for proper correction. The pertinent anatomy of this area -- the theories, causes, suggested methods of prevention and correction -- are presented.


Symposium: the supra-tip in rhinoplasty: a dilemma. II. Influence of surrounding structure and prevention. One of the most annoying complications of rhinoplasty is the supra-tip hump (pollybeak). Possible causes are failure to surgically compensate for: 1. The increased skin thickness above the tip. 2. Supra-tip keloid tendency. 3. Overactive depressor septi muscles. 4. Loss of natural tip support by the upper lateral cartilages and septum.


Symposium: the supra-tip in rhinoplasty: a dilemma. III. Supra-tip soft-tissue rounding after rhinoplasty: causes, prevention and treatment. 1. During rhinoplasty the surgeon can easily set in motion changes which produce soft-tissue rounding of the supra-tip area postoperatively. 2. Preventive as well as therapeutic measures are discussed.


Symposium: contraindications to tympanoplasty. II. An exercise in clinical judgment. The two primary symptoms of chronic ear disease are otorrhea and hearing loss. The goal of any tympanoplasty is to eradicate disease and improve hearing. These are the primary indications for this procedure. The success or failure of the surgery is influenced by many factors such as the age and general health of the patient, the extent and type of disease present, and whether the upper airway is functioning properly. Contraindications to tympanoplasty will vary from one surgeon to another depending upon his training, philosophy, experience, and surgical skill. It is helpful to think of these contraindications as being either absolute or relative. Absolute contraindications consist of: 1. uncontrolled cholesteatoma; 2. malignant tumors; 3. unusual infections and/or extenuating circumstances; and 4. complications of chronic ear disease, such as meningitis, brain abscess, or lateral sinus thrombosis. Relative contraindications are less well defined: 1. eustachian tube insufficiency or non-function; 2. the uncooperative patient; 3. the dead ear; 4. the better hearing or only hearing ear; 5. the elderly patient; 6. the young child; and 7. the repeated failure case. The otologic surgeon must exercise good clinical judgment in selecting patients for tympanoplasty. This paper deals with some of the more common problems in decision making.


Symposium: contraindications to tympanoplasty. IV. Contraindications to tympanoplasty. Aural and non-aural disorders that are relative or are absolute contraindications to tympanoplasty surgery are discussed. Particular attention is focused on non-aural convert general medical conditions that may escape the otologist's attention as he is not daily concerned in the management of such conditions. The aural contra-indications are dealt with briefly because of the obvious and well known disorders that are familiar to all otologists.


Familial laryngomalacia: a case report.

Familial laryngomalacia: a case report. This report describes the hereditary occurrence of severe laryngomalacia in three of five siblings of a Mexican-American family. The mother, who experienced respiratory difficulties in the first year of life, may also have been affected. All three affected children required neonatal tracheostomy, and two died of pulmonary complications. Histological studies of tracheal cartilage revealed distinct hypercellularity and histochemical staining abnormalities of the cartilaginous matrix without defects in skeletal cartilage. Although laryngomalacia is not uncommon, this disorder previously has not been documented to occur as a familial trait, nor have distinct abnormalities of cartilage been associated with laryngomalacia. This report suggests that etiologic and pathophysiologic heterogeniety exists for the clinical syndrome of laryngomalacia.


Ischemic paralysis of the facial nerve: a possible etiologic factor in Bell's palsy. Numerous causes of peripheral facial nerve paralyses have been described; however, none has satisfactorily explained the genesis of the most common type of paralysis, Bell's palsy. Two patients undergoing an experimental embolization of vascular intracranial tumors suffered a total peripheral facial nerve paralysis when occlusion of the middle meningeal artery had been accomplished. It is speculated that this paralysis resulted from ischemia of the horizontal portion of the facial nerve, an observation that has not previously been described and that might be applicable as well to the etiology of Bell's palsy.


Rhabdomyoma of the pharynx.

Rhabdomyoma of the pharynx. The occurrence of a large pharyngeal rhabdomyoma in an otherwise healthy adult male is discussed in this paper. This lesion, except for local symptomatology, is established as benign. A differential diagnosis, as well as the specific surgical approach to its removal, are also presented.


Tracheostomy in infants and young children. Seventy-three tracheostomies performed in children three years of age and under in a 52-month period are discussed. Thirty-six were under one year of age. Forty-one were performed for upper airway obstruction, 23 for ventilation or suction, and nine for a combination of upper airway obstruction and lower bronchopulmonary disease. Operative complications developed in 10 patients, and postoperative complications in 16. The most common complication was interstitial air; the most deadly was obstruction of the cannula. There were 20 deaths. Sixteen were due to the patients' diseases; four were due to complications of tracheostomy. If serious operative and postoperative complications are avoided, the important factors determining prognosis are the patient's age and the condition for which the tracheostomy was done. The long term results in these patients show this to be true for both survival and duration of tracheostomy.


Laryngeal suspension in head and neck surgery. Nineteen cases with major resections of the head and neck were treated with laryngeal suspension and cricopharyngeal myotomy in an attempt to allow swallowing function postoperatively and avoid a total laryngectomy. Sixteen cases were available for evaluation. Eight cases (50%) were able to eat by mouth, 15 patients (94%) had a normal airway and 14 patients (87%) had intelligible speech.


The cochlear implant; basic principles.

The cochlear implant; basic principles. In recent years the cochlear implant has been a subject of much discussion and controversy. The clinician has often been confused by the conflicting reports of success and failure. In this paper the development of the cochlear implant is reviewed and its present status summarized. It is hoped that the clinician may thereby gain an understanding of this device so that he can better evaluate its present and future status. Selection of Patients for Cochlear Implantation. The cochlear implant will benefit only those patients with hair cell loss who have remaining viable auditory neurons. In order to determine whether viable neurons remain, an electric current is passed through a small needle which is place into the promontory through the tympanic membrane. If patients experience an auditory sensation as a result of this electrical stimulation, it is felt that they are suitable candidates for a cochlear implant. Feasibility of Long-Term VIIIth Nerve Stimulation. Many questions have been raised regarding the feasibility of long-term stimulation of the auditory nerve. The first question raised was whether the auditory nerve would survive severe hair cell degeneration. Studies have shown that in most cases at least a few auditory neurons remain. The next question was whether the cochlear implant itself would destroy the remaining auditory neurons. Preliminary studies have shown that the nerve will survive the placement of electrodes both into the modiolus and the scala tympani. Several electrode materials and insulation have been found to be well tolerated, and there has been minimal damage from thermal or electrolytic processes; therefore, it appears feasible to stimulate the auditory nerve over a long period. Information Transfer by Electrical Stimulation. Single-channel stimulation produces only periodicity pitch, and information transfer is insufficient for speech discrimination. Experience to date indicates that it will be possible to produce both place and volley pitch by electrical stimulation with multiple electrodes in the scala tympani. These findings give promise for the feasibility of producing a device which will transfer sufficient information to produce speech discrimination. Present Status of the Cochlear Implant. To the present time 15 patients have been implanted with a unipolar electrode under the direction of the Ear Research Institute. These patients have all benefited from their devices. They are able to perceive background sounds and receive a cadence or rhythm to speech which makes the device helpful in lipreading. None of the patients have developed significant speech discrimination.


Sudden sensori-neural hearing impairment: a report of 1,220 cases. We reviewed the findings in 1,220 cases of sudden sensori-neural hearing impairment encountered over a nine-year period at the Otologic Medical Group. A thorough neuro-otologic evaluation is indicated in each case. Ten patients had an acoustic tumor. A vasodilator regimen was prescribed in 380 cases and resulted in hearing improvement in 40%. Favorable prognostic findings were a low tone loss and absence of vertigo.


Hearing impairment caused by intratympanic pressure changes during general anesthesia. Hearing impairment is not often considered a potential complication of general anesthesia; however, four patients who sustained hearing loss following nitrous oxide inhalation anesthesia have recently come to the authors' attention. The cases are presented and middle ear pressure measurements taken during endotracheal inhalation anesthesia with various agents are reported. Factors predisposing to hearing loss during anesthesia are discussed.


Carcinoma of the external auditory canal. Successful management of carcinoma of the external auditory canal depends upon four factors: 1. early diagnosis is imperative if a high cure rate is to be expected; 2. correct evaluation of the extent of the malignancy; 3. adequate surgery based upon correct evaluation; and 4. postoperative radiation in certain selected cases. In this review of 35 cases, two factors were used to determine whether the disease was localized or extensive. When extension occurs inot the mastoid as deep as the middle ear cleft or into the facial nerve, it should be designated as extensive tumor. Tumors which do no go as deep as the facial nerve or involve the mucosa of the middle ear should be designated as localized tumors. In localized tumors, it is possible to perform a wide en bloc resection of the bony and cartilaginous external auditory canal including the tympanic membrane and malleus, and if necessary, including the superficial lobe of the parotid. Postoperative radiation is indicated when the pathological specimen shows unclear margins in the surgical dissection. With localized tumors, en bloc resection of the external auditory canal offers a high cure rate. In extensive lesions, an en bloc dissection removing the bulk of the tumor mass, followed by irradiation, seems to offer at least as good a prognosis as more radical surgery.


Stapedectomy: gelfoam compared with tissue grafts. The commonest causes of failure with the prefabricated wire loop-gel foam pad technique are inferior displacement of the loop in the window, high membrane formation and window fibrosis. As a result of these problems some members of the Otologic Medical Group have abandoned the use of gelfoam in favor of tissue grafts. A comparison of the results with gelfoam, fat grafts, and fascia grafts in 573 primary cases is made. Tissue grafts yielded a lower incidence of postoperative vertigo, of temporary and permanent sensori-neural hearing impairment, of fistulas and of long-term hearing regression. The conclusion is that a tissue graft is preferable to gelfoam as an oval window covering in stapedectomy.


Technical note: A finger extension tongue depressor. The author describes a tongue depressor which can be adapted to the examiner's thumb while performing indirect laryngoscopy. This depressor allows the examiner to pull the tongue and push it downward in patient where otherwise vision is obscured by the dorsum of the tongue.


[Conductometric method of studying aggregations of the formed elements of the blood]. To study an aggregation of formed blood cells a setup is proposed in which use is made of the conductometric method of measuring the resistance of a fine-pore filter through which the blood passes. A specially devised sensor allows it also to study the process of the cells aggregation in the vascular system of test animals and to control the dispersion of formed cells in the apparatus of extracoporeal circulation. Among advantages offered by the method are the objective character of measurement, the possibility of investigating the whole blood and due consideration of the part played by hydrodynamic factors.


[State of and prospects of the standardization of medical engineering terminology]. With a view to standardizing the biomedical engineering terminology some recommendations on elaborating scientific classification of terms covering the field of biomedical engineering and serving as a background to their formation are given.


[Principles of the unification of medical instruments]. Taking as a basis the calculation of the unification level index made according to the formula adopted in general machine building industry the need for determining the principle underlying the approach to unification of medical instruments is demonstrated. The paramount methodical prerequisite for unification of medical instruments is outlined and the unification of not only structural elements of the latter, but also of their mutual disposition is substantiated.


[Hardening and polishing of polymeric articles for medical purposes]. Physico-mechanical and performance characteristics of manufactured articles made of polymers can be improved by treating their surfaces with active solvents during a certain period of time and at a fixed temperature. In such cases the solvent acts upon the molecular structure of the surfacial layer in the polymer, fills and cements its defects. Investigations carried out demonstrated that a short-term action of the solvent improves the durability and toughness of the articles, tends to raise their biological indifference and makes their external appearance look better.


[Some problems in the use of holography in medical-biological studies]. Various fields of the holographic methods application in medico-biological investigations are discussed. Special consideration is given to the methods of holographic interferometry, holographic microscopy, ultrasonic holography and to the technique of optic filtration of images. The paper sets forth brief characteristics of diverse holographic methods, technical possibilities of each one of them and a review of some practical work done in this field.


[Improved stand for the IVCh-02 pallesthesiometer]. A support for the pallesthesiometer, model IVCh-02, which permits it to fix the position of the supper limb in measuring the vibration sensitivity threshold is proposed. This design ensures a stable digital pressure on the vibrator. The threshold levels of the vibration sensitivity registered by using this support are distinguished by lesser variability and greater accuracy as compared to those obtained with the batch-manufactured support.


[Serial spot roentgenokymography of the lungs]. A procedure employed in examining pulmonary functions with a Soviet-made roentgenokymograph and by using serial roentgenokymography is described. The procedure is relatively simple and can be effectively applied in any X-ray room. Four series of roentgenokymograms showing mid-segments of the both patient's lungs can be obtained on a single film with different respiration rates under physiological conditions and in making functional tests.


[The model EN-57M apparatus for high-frequency electric surgery]. The model EN-57M apparatus is intended for cutting and coagulation of soft tissues with high-frequency currents and it represents a modernized version of the Model EN-57. In this new model the number of outlets has been increased, the set of accessories -- improved, the complement of monoactive electrodes -- broadened, a biactive pincer -- added and the design of passive electrodes -- changed. The active electrodes, electrode-holders and cables attached to them are manufactured of materials permitting their steam and air sterilization. Particular consideration has been given to the electric safety of the apparatus in providing protection against burns caused by the high-frequency current.


[Technical means for the segmental perfusion of the small intestine]. One of the most exact methods of diagnosing disturbed absorption is perfusion of the small intestine. To make pertinent investigations a special perfusion probe manufactured of a roentgen-contrast rubber and a peristaltic pump for introducing a perfusion solution into the lumen of the intestine are proposed. A procedure used in conducting the examination is described and a formula for determining the absorption rate is given.


[Informative nature of the "momentary" pulse in arrhythmia]. Changes in the "momentary" pulse characteristics serve as a possible background to establishing a tentative diagnosis of arrhythmias. The method is based on the evaluation of alternation of shortened and lengthened intervals between cardiac contractions and also on the appearance of isolated shortened or lengthened intervals between cardiac contractions.


[Methods of input into a digital computer of low-frequency physiological data]. A procedure employed for input of low-frequency physiological information coming via several channels in a digital computer, model M-220A has been worked out. The operations are effected through the application of standard equipment with the use of routine communication channels to the computer. Particular attention is attached to the storage of the input information in the permanent memory of the machine for further synchronous analysis of physiological indices. The procedure may find use in analyzing materials covering a wide range of medico-biological experiments.


Neurological manifestations and morbidity of hyponatremia: correlation with brain water and electrolytes. 1. An attempt was made to evaluate the pathophysiology of symptoms of hyponatremia as related to changes in brain water and electrolytes. Studies were carried out in 66 hyponatremic patients and 5 groups of experimental animals. 2. In hyponatremic patients, symptoms (depression of sensorium, seizures) correlated well with plasma Na+ (r = 0.64, p less than .001), but there was substantial overlap. In patients with acute hyponatremia, all were symptomatic and 50% died. Among patients with hyponatremia of at least 3 days duration, sympatomatic patients had plasma Na+ (115 +/- 1 mEq/L) which was significantly less (p less than .001) than that of asymptomatic patients (plasma Na+ = 122 +/- 1 mEq/L). Among symptomatic patients, mortality was 12% and 8% had seizures, while none of the asymptomatic patients died or had seizures. 3. Among 14 patients with acute (less than 12 hrs) hyponatremia, the mean plasma Na+ was 112 +/- 2 mEq/L. All such patients had some depression of sensorium and four had grand male seizures. Seven of these patients were treated with hypertonic (862 mM) NaCl, while four were treated only with fluid restriction. Of the seven patients treated with hypertonic NaCl, five survived, while three of four patients treated with fluid restriction died. There was no evidence of circulatory congestion or cerebral damage in the patients treated with hypertonic NaCl. 4. Among rabbits with acute (2-3 hours) hyponatremia (plasma Na+ = 119 +/- 1 mEq/L), all had grand mal seizures and 86% died. All such animals had cerebral edema (brain H2O content 17% above control value) but brain content of Na+, K+ and Cl- was normal.  5. Rabbits with 3 1/2 days of hyponatremia (plasma Na+ = 122 +/- 2 mEq/L) appeared to be asymptomatic, even though brain water content was 7% above normal (p less than .01). 6. Rabbits with 16 days of more severe hyponatremia (plasma Na+ = 99 +/- 3 mEq/L) were weak, anorexic, lethargic and unable to walk. Brain water content was 7% above normal, although brain osmolality (218 +/- 12 mOsm/kg H2O) was similar to plasma (215 +/- 8 mOsm/kg). Brain content of Na+, K+, Cl- and osmoles was 17 to 37% less than normal values, so that the brain established osmotic equilibrium with plasma primarily by means of a loss of electrolytes. 7. These studies suggest that in patients with hyponatremia, symptoms and morbidity are only grossly correlated with either magnitude or duration of hyponatremia. Symptoms appear to correlate best with the interplay between a net increase in brain water versus a loss oof brain electrolytes. However, even asymptomatic animals have subclinical brain edema when plasma Na+ is below 125 mEq/L, and such edema may cause permanent brain damage. Thus, many patients with similar levels of plasma Na+, particularly when they are symptomatic, should probably be treated with hypertonic NaCl infusions.


[Fine-needle aspiration biopsy in the diagnosis of thyroid diseases (author's transl)]. 879 fine-needle biopsies obtained from 754 patients with palpable lesions of the thyroid were evaluated. Cold nodules were identified in the scintigram of 509 patients. The cytologic findings could be checked by histology in 102 cases. 24 out of 26 malignant tumors of the thyroid were recognized cytologically. In 23 cases the tumor type was correctly identified by cytology. The cytologic report was false negative in two cases. Follicular adenoma and follicular carcinoma are not distinguishable on cytologic grounds. In 14.7% of patients the cytologic report stated cystic lesions and in 1.7% of patients inflammatory lesions.


[Clinical significance of serum magnesium concentration in thyrotoxicosis (author's transl)]. Thyrotoxicosis is associated with hypomagnesemia. Therapy leads to restoration of serum magnesium concentration. The clinical significance of the disturbance in magnesium metabolism is discussed on results of two groups of patients with hyperthyroidism. One group of 7 patients with high serum thyroxine levels and mild clinical signs of thyrotoxicosis showed a normal magnesium concentration in serum. In a second group with further 7 patients serum magnesium level did not increase during therapy while thyroxine decreased in spite of lack of clinical improvement. The results suggest that serum magnesium concentration is primarily determined by 1-triiodothyronine.


[Effect of experimentally induced hyperthyroidism on zona glomerulosa from adrenal cortex of the rat (author's transl)]. By histochemical and histometrical methods the the effect of l-triiodothyronine on the zona glomerulosa from rat adrenal cortex was investigated. Glucose-6-phosphatedehydrogenase and 3-beta-OH-steroiddehydrogenase activities were determined in slices of adrenal cortex. No increase in activities of these enzymes was observed after treatment with l-triiodothyronine. In contrast, histometrical studies showed a significant enlargement of nuclei in the zona glomerulosa as well as in the zona fasciculata. This observation suggests enhanced secretory activity of both zones of the adrenal cortex of the rat.


[Clinical experience with a new method for the determination of monoglyceride lipase (author's transl)]. The activity of monoglyceride lipase was studied in plasma from 74 patients with liver disease in whom blood was drawn 10 min after the injection of heparin (10 U/kg body weight). The results were compared with the activities from 29 healthy volunteers. For measurement a new, easy to handle method was used. The patients showed significantly lower activities, e.g. in chronic aggressive hepatitis there was a decrease by 87%. There was no correlation between the activities of monoglyceride lipase and pseudocholinesterase which also can be decreased in liver disease. The results show that the determination of monoglyceride lipase appears to be a useful test of the liver's function. Its value probably lies in the evaluation of the vessels.


[Comparison between a titrimetric and a photometric method for determination of serum lipase activity (author's transl)]. Comparative studies of two methods for the determination of serum lipase activity (SLA) in human serum show in both methods, the one titrimetric the other photometric, a comparable sensivity and comparable results, especially within the group of subjects suffering from pancreactic diseases. The values of SLA within the group of 45 patients with acute and chronic pancreatic diseases and within a control group of 39 persons without pancreatic affections show a marked correlation for each group. The values of SLA obtained with the titrimetric method of Rick are found to be higher, which would be due to better conditions of the procedure. Also in the study of precision the titrimetric method gave a better result. The determination of SLA with both methods includes post-heparin-lipase-activity (PHLA).


[Distribution pattern of isoenzymes of alkaline phosphatase in patients with various forms of hepatitis (author's transl)]. The isoenzymes of alkaline phosphatase were measured on admission to hospital, and then weekly over a 2 to 3 month period, in 40 patients presenting with uncomplicated acute hepatitis, 12 patients with cholestatic hepatitis, and 10 patients with histologically confirmed chronic persistent hepatitis. In acute uncomplicated hepatitis the increase in total alkaline phosphatase is not due to a cholestatic reaction of the damaged liver, but reflects the impaired catabolic capacity of the liver cells to degrade alkaline phosphatases from intestine and bone, as well as that of hepato-biliary origin. The isoenzyme distribution pattern is the same as found in normal healthy subjects. The increase in total alkaline phosphatase in patients with cholestatic hepatitis results from this impaired catabolic capacity for degradation of all isoenzymes, together with an increase in cholestatic reflux of hepato-biliary enzymes. In patients with chronic persistent hepatitis the raised total alkaline phosphatase activity at each point during the illness is due to this catabolic impairment of degradation of all isoenzymes. A cholestasis is not seen. The isoenzyme distribution pattern remains normal; only the enzyme activity due to the intestinal fraction, when compared with the acute hepatitis, is slightly, but significantly, raised.


[Hormon producing tumors of the pancreas. Verner-Morrison like symptomatology of a non-serotonin-producing, metastasizing carcinoid of the pancreas (author's transl)]. A case of Verner-Morrison like symptomatology of an histological identified, metastasizing, non-serotonin-producing carcinoid of the pancreas is described. The likeness of symptomatology to courses of disease by islet-cell tumors is pointed out, the coincidence of carcinoid and islet-cell-tumors and their common origin are discussed.


[Salivary and duodenal amylase production in patients with chronic hepatic diseases (author's transl)]. Investigating patients with chronic diseases of the liver, there will sometimes be found a symmetric hypertrophy of the parotid glands. Supposing, that enlargement of the parotid glands could equal an enhancement of parotid function, the authors investigated amylase and volume production of the parotid glands and at the same time that produced by pancreatic excretion during pancreozymin/secretin stimulation. They found a compensatory action of the parotidean function: In patients with only small liver cell damage they saw a diminished parotidean function together with an enhanced pancreatic excretion. In cases with severe liver cell alteration, the parotidean function was found to be greater than in normals, the pancreatic function diminished. The authors estimate the parotidean hypertrophy as a morphologic equivalent to the compensatory enhancement of parotidean function in cases with chronic liver diseases.


[The serum prealbumin significance in differential diagnosis of the liver diseases (author's transl)]. We investigated the serum prealbumin by the immuno-diffusion method quantitatively according to the method of Manzini in 20 normal persons, 30 patients with hepatitis virosa acuta, 24 patients with hepatitis chronica and 11 patients with cirrhosis of the liver. The serum prealbumin was significantly decreased in patients with hepatitis acuta virosa, hepatitis chronica aggressiva and in cirrhosis of the liver, but in the patients with the hepatitis chronica persistens the serum prealbumin levels were normal or little increased. According to our results we concluded that the determination of serum prealbumin is important only for the differential diagnosis between the hepatitis chronica aggressiva and hepatitis chronica persistens. However these determinations are not of values in the differential diagnosis between hepatitis chronica aggressiva and cirrhosis of the liver.


Test cassette for measuring peak tube potential of diagnostic x-ray machines. A test cassette employing a modification of the Ardran-Crooks attenuation technique for measuring peak tube potential (and half-value layer) is described. The technique employs a radiographic intensifying screen which is exposed to a hardened x-ray beam. Copper penetrameters are used to determine the attenuator thickness which reduces the light output from the screen to that transmitted by an optical attenuator over an adjacent area of the screen. The test cassette was calibrated by using x-ray machines whose high voltages were measured electrically. The test cassette has a measurement precision of +/- 1 kVp and an accuracy of +/- 3 kVp or better in the range 50-130 kVp for x-ray generators with the same voltage waveform.


Computer dosimetry for flattened and wedged fast-neutron beams. Beam flattening by the use of polyethylene filters has been developed for the 50-MeV d in equilibrium Be fast-neutron therapy beam at the Texas A&M Variable-Energy Cyclotron (TAMVEC) as a result of the need for a more uniform dose distribution at depth within the patient. A computer algorithm has been developed that allows the use of a modified decrement line method to calculate dose distributions; standards decrement line methods do not apply because of off-axis peaking. The dose distributions for measured flattened beams are transformed into distributions that are physically equivalent to an unflattened distribution. In the transformed space, standard decrement line theory yields a distribution for any field size which, by applying the inverse transformation, generates the flattened dose distribution, including the off-axis peaking. A semiempirical model has been constructed that allows the calculation of dose distributions for wedged beams from open-beam data.


High-resolution dosimetry with stimulated phosphorescence. Thermally stimulated radiophosphorescence has been studied as a means of high-resolution dosimetry. Small grains of CaSO4:Mn phosphor, embedded in a thin Teflon tape, constitute the dosimeter. The light emitted after irradiation is measured with a photomultiplier coupled to the eyepiece of a scanning microscope. With CaSO4:Mn, the phosphorescence at room temperature is sufficient for measurement after doses in excess of 3000 rads. The spatial resolution of the technique is about 0.2 mm. The method has been tested by measuring the dose distributions from a radium needle and a beta-emitting eye applicator.


Hydrophobic surface properties of erythrocytes studied by affinity partition in aqueous two-phase systems. Erythrocytes from various species have been partitioned in aqueous two-phase systems consisting of water, dextran, poly-(ethylene glycol), salt and buffer. The terminal hydroxyl groups of the latter polymer were esterified with palmitic, oleic, linoleic and linolenic acids, as well as with deoxycholic acid. In a two-phase system containing unesterified poly(ethylene glycol) the erythrocytes are exclusively in the dextran-rich lower phase. When the poly(ethylene glycol)-rich upper phase depending on the type and concentration of esterified acid. Palmitate ester is most effective in increasing the affinity of the cells for the upper phase, followed by oleate, linolate, linolenate, and deoxycholate esters. The partition behaviour of erythrocytes from various species differs considerably. Two groups can be distinguished: one consisting of erythrocytes from dog, guinea pig and rat, the other from human, sheep and rabbit. This division can be correlated to the content of sphingomyelin and phosphatidyl choline in the erythrocyte membranes.


[Methods of approach used by physicials untrained in behaviour therapy to reduce anxiety in children undergoing routine examination (author's transl)]. Samples of pediatricians (N = 50), general practitioners (N = 50) and doctors of a children's hospital (N = 30) were asked to rate the intensity of children's anxiety for 15 items of routine medical performances. In addition the first two groups were asked about the technique used to reduce children's anxiety or to hold it on a low level. The questionnaires were analysed under the following aspects: 1) Are there systematic differences between the three groups concerning the estimation of infantile fear-intensity?--2) Is it possible to express the described behaviour doctors regard as effective for anxiety-reduction in terms of learning theory or behaviour-therapy respectively?--3) Is there a statistical interaction between the estimation of fear-intensity and ways of approaching?--Concerning the estimation of children's fear-intensity the three groups turned out to be highly concordant. Nearly 60% of pediatricians and general practitioners at least once during a session use approaching-techniques in the sense of learning theory. There is no interaction between the two variables "fear-intensity-estimation" and "mode of approach".


[The application of a combined Xylose-lactose tolerance-test in children with suspected malabsorption (author's transl)]. A combined xylose-lactose tolerance-test and a duodenal biopsy were performed in 68 children with suspected malabsorption-syndrome. The purpose of the present work was to assess the diagnostic value of xylose concentrations in blood at different times and to determine the additional discriminatory value to glucose levels. The contribution of the glucose rise to a calculated discriminant function is statistically significant but practically negligible and therefore does not justify its determination. A small-bowel biopsy is recommended if the concentration of xylose after 60 min is less than 26 mg/100 ml or the increment of xylose concentration above fasting level is 18 mg/100 ml or less.


[Intermittent branched--chain ketoacidurie in ketotic hypoglycemia: investigations to localize the biochemical defect (author's transl)]. We are reporting a girl aged eight years with ketotic hypoglycemia, mental deficiency and retarded motor and somatic development. Investigation of plasma amino acid concentrations during a spontaneous hypoglycemia revealed an increase in the branched-chain amino acids valine (4.1), leucine (7.8) and isoleucine (1.7 mg/100 ml), while alanine was decreased (1.2 mg/100 ml) and ketonuria was present. The determination of the branched-chain ketoacid decarboxylase in leukocytes showed a decrease of approximately 50% of normal for alpha-ketoisocaproic acid (KIC) as substrate, whereas values for alpha-ketoisovaleric acid (KIVA) and alpha-keto-beta-methylvaleric acid (MEVA) were normal. In fibroblasts activities for all three substrates were in the normal range. Intermittend maple-syrup-urine disease was excluded by oral loading tests with the branched-chain amino acids and with an isocaloric, high-protein diet. Impairment of oxydative decarboxylation of leucine, valine, and isoleucine secondary to increased ketogenesis may play an etiologic role in ketotic hypoglycemia, since we observed, by gaschromatographic analysis, an increase in the urinary excretion of KIVA (5.5 mumol/h), KIC (29.4), and MEVA (47.9) after a provocative test with an isocaloric ketogenic diet for 36 hrs. The significance of branched-chain hyperaminoacidemia and branched chain alpha-ketoaciduria is discussed in this context.


[Cerebral salt loss as Schwartz-Bartter-syndrome in childhood (author's transl)]. Schwartz-Bartter-syndrome as a consequence of severe cerebral alterations like bacterial and tuberculous meningitis, encephalitis, hydrocephalus and brain haemorrhage has been observed in 7 cases. Massive natriuresis is followed by marked hyponatremia and hypochloremia which may lead to an intracellular brain edema. Sodium administered even in high dosage is lost rapidly through the kidney, and does not normalize the serum level of sodium. The Schwartz-Bartter-syndrome is caused by inadequatly elevated ADH-secretion with consecutive water retention and an increase in plasma volume. Consecutively an increased excretion of sodium takes place causing a substantial loss of bound water. An analogous situation was seen in a child with neurohormonal diabetes insipidus after an overdosage of ADH, which resulted in a hypervolemia, marked hyponatremia and massive natriuresis. The increased excretion of sodium may be the result of reduced reabsorption of sodium in the proximal tubuli of the kidney, caused by a humeral natriuretic factor (the socalled "third factor"). In the serum of one of our patients an increased natriuretic activity could be shown; this is the first time in a child with Schwartz-Bartter-syndrome.


[The therapeutic significance of bronchial suction-drainage in infants]. Bronchial suction-drainage in infants--according to our observations--is a life-saving procedure in cases of aspiration, severe bronchitis and retention of bronchial secretion. It can also be very effective in atelectasis, bronchopneumonia and pulmonary abscess. The earlier the drainage the quicker the clearing up of the atelectasis. An additional indication for performing bronchial suction in severe lower respiratory tract infections is to gagain secretion for bacterial culture. This is especially important in the Gram negative and Staphylococcus infections of young infants. The right upper pulmonary lobe is the most common localisation for atelectasis and pneumonia in this age group. One possible explanation for this could be that malformed bronchi are more frequently found in the right than in the left upper lobe. It is such a characteristical phenomenon in infancy that we called it "the right upper lobe syndrome".


[Summer holiday camp for children with chronic renal disease (author's transl)]. A summer camp was organized for 31 children with chronic renal disease. One third of the patients suffered from renal insufficiency. The medical and paedagogical problems which evolved during the stay could be solved satisfactorily under relatively simple external conditions. The camp offered opportunity for the detection of hidden psychosocial and behavioral problems induced by the disease. These could be treated appropriately. The most important prerequisite for the organization of summer camps of this kind is a well-trained and coordinated team which should include a paediatric nephrologist, psychologists, teachers, dieticians and social workers.


[Hemodialysis in a child with accidental digitalis poisoning (author's transl)]. A case of an accidental digitalis intoxication in a two year old child is reported. Early Hemodialysis effectively reduced the high plasma levels of digoxin and replaced other therapeutical procedures.


[Rapidly progressive glomerulonephritis in a child. Clinical and histological observation over 3 1/2 years (author's transl)]. At the age of 5 years and 10 months a boy suffered from rapidly progressive glomerulonephritis. After 14 days of treatment with peritoneal dialysis and chlorambucil the acute renal failure was overcome and the kidneys started to function again. 3 1/2 years later 2/3 of normal values for glomerular filtration had been regained, though proteinuria is still 2,8 g/day. Histologically mainly extracapillary proliferations and a partially necrotizing glomerulonephritis were seen in the beginning. 1 1/4 years later sklerosed glomerula predominated (80%) over almost normal glomerula with only minor proliferations. The prognosis remains doubtful in spite of the benign course in the beginning.


[The campomelic syndrome (author's transl)]. Case report of a male infant who died from asphyxia on the second day of life and who exhibited typical features of the campomelic syndrome: odd facies, bowing of the long bones of the legs, skeletal deformities, cleft palate. There was also coarctatio of the aorta and probably aplasia of the fibula.


[DeBarsy-Moens-Dierckx-syndrome (author's transl)]. The symptoms of DeBarsy-Moens-Dierckx-syndrome previously described only in single patients, have been observed in a brother and a sister. Both children showed dwarfism, dystrophy, oligophrenia, an old looking face, and a typically lax skin and cloudy cornea as signs of degeneration of the elastic tissue. Moderate pathological changes were also found in the electroencephalogram, the echoencephalogram, and the X-ray films of the wrists. The analysis of the chromosomes and many other laboratory data were normal. The family-history gave no clue as far as the heredity mode is concerned. As far as we know this is the first description of this syndrome in siblings.


[Ultrastructure of the interstitial cells of the rat kidney medulla]. Ultrastructure of the interstitial cells of the internal zone of the medulla of kidney in rats is detailly described. Electronmicroscopical feature of these cells may be connected with several functions i.e. urine-concentration, electrolyte-transport, production of intercellular matrix and vasodepressor-lipids. Ultrastructural picture of production and elimination of lipid droplets is not yet cleared out. Authors stress, that for the appropriate fixation of zones of different ion-concentration of the medulla special fixatives of an appropriate osmotic pressure are necessary.


[Electron microscopic observations in leukoedema exfoliativum mucosae oris (white sponge nevus)]. Biopsia taken from 13 cases of leukoderma exfoliativum mucosae oris (white sponge nevus) was investigated by the aid of electron microscope. Significant changes as compaired to the normal ultrastructure were revealed. The disease is a hereditary one manifesting itself in the disturbance of differentiation of epithelial cells mainly of the oral mucosa. Arrangment of the tonofilaments is disturbed, formation of tonofibrills and keratohyaline granules ceases. Odland-bodies occure in a great number but the lack of emptiing their content into the interecellular space is striking. Exfoliation of the epithelial cells diminishes, presumably because of the disturbance of their enzymatic function and the presence of a great number of desmosomes between the cells of the superficial layer. The diminished exfoliation histologically and clinically produces a hyerplasia of the epithelium with an enormous quantitity of superficial epithelial cells.


[The effect of atherogenic diet on the entering of albumin into surviving segments of rabbit aortic wall]. Damage to the endothelial cells in the early phase of atherosclerosis is of essential importance. Presence of an anhomogen layer of endothelial cells revealed in vivo, represents an early lesion of the area of vessel well influenced heavily by haemodinamics. Authors have established that entering of albumin into the aortic wall of rabbits exposed to a cholesterin-rich diet in the early phase of atherosclerosis-in vitro-increases, but later on in the advanced phase of the disease decreases, which can be explained by the slow-down of the speed of diffusion into the vessel wall. Accumulation of plasma-constituents in the vessel wall in the early phases of the vascular lesion is caused by the increase of entering of the plasma, in the advanced stages by the slow-down of the speed of diffusion.


[Changes in the structure of the wall of the human thoracic duct in relation to atherosclerosis and age]. Changes in the proportion of muscular- and connective tissue in the media of the thoracic duct were observed at atherosclerotic persons. It was established that the quotient of the muscular and connective tissue with the development of the atherosclerotic process increases. The latter causes thichkening of the connective tissue layer in the wall of the thoracic duct. These structural changes have only indirect connection with age, since severe atherosclerosis in aged persons occure more often.


[Unusual case of fire-arm injury].

[Unusual case of fire-arm injury]. A rare case of firearm-injury is described. The bullet getting into the sigmoid colon by the antiperistaltics was transferred into the colon transversum.


[Gas chromatography of alcoholic beverages]. The author carried out investigations on mixed fruit and grape brady obtainable in shops, as well as on the alcohol of the mixtures of 500 wine samples by means of gaschromatography, partly without preliminary preparation, and partly after extraction with ether and pentane respectively. It was established that the extraction method with ether and pentane accepted in the literature is suitable for the concentration of the side products of alcoholic beverages and thus for their gaschromatographic qualitative analisis as well. When examing higher alcohols - and also other side-products - the direct, examination without preliminary preparation must be given preference, because in this case there is also a possibility for quantitative determination. On the basis of his results the author considers an increased quality control of home distilled brandy necessary as well as the determination of alcohols of higher order, because in some cases he has detected a greater quality of fusel oil content than permissable (400 mg/100 ml albolute alcohol).


[Forensic problems of fatal hand-inflicted injuries]. In the last years in Hungary continual decrease of homicidal cases could be registered, however other forms of violence, severe injuries followed by the death of the victim are almost as high as formerly. Author in the last ten years performed autopsy of 14 such cases. On the base of them summarizes problems arising in connection with the medico-legal investigation of them. He concludes that among these problems-beside alcoholic intoxication-the most important is to reveal the natural disease-if any-of the victim. If there is a natural disease it may be accounted as a factor in the death. Then the crime can be evaluated as a praeterintentional one.


[Electron microscopic study of kidney biopsy specimens from children]. Investigation of kidney-biopsy taken from 17 children was carried out. The techniques used were: light-microscopic investigation of paraffin sections and ultrathin sections, electron microscopic investigation of the latter and basal-membrane measurements. According to the author's opinion electron microscopic investigation of kidney-biopsy is reasonable only in selected cases, representing special clinical and therapeutic problems. In cases of nephrosis syndrome electron microscopy helps in differentiation of the "mimimal lesion" and the early phase of the focal sclerotizing glomerular lesion. Further it gives good results in observation of mono- and olygosystemic diseases of the kidney. In the author's material electron microscopy contributed to more differentiated morphological diagnosis in 2/3 rds of the cases investigated. The authors join to the opinion of other investigators stressing that light-microscopical investigation should be completed by the light-microscopy of uktrathin scretions even then, when there are no possibilities of electonmicroscopical study.


Sucrase-isomaltase deficiency. Absence of an inactive enzyme variant. Deficiency of sucrase-isomaltase, an intestinal enzyme complex that is essential for digestion of nutritionally important carbohydrates, appears to be inherited as an autosomal recessive in 0.2 per cent of North Americans. The molecular basis of the deficiency has not been elucidated. To characterize the enzyme defect quantitatively, papain-solubilized intestinal biopsies were analyzed for total enzyme protein by radioimmunoassay and for enzyme activity by hydrolytic assay. Normal intestine had a close correlation between immunologically reactive enzyme and enzymic activity. In contrast, seven patients with sucrase-isomaltase deficiency were found to have complete absence of the enzyme protein by radioimmunoassay even though up to 10 times more intestinal protein was present than with normal tissue. This absence of an inactive enzyme variant can be explained by a major (no-sense) mutation of the structural gene or by a complete repression of the regulatory mechanism that controls structural gene function.


Salicylate-induced injury of pyruvate-kinase-deficient erythrocytes. Salicylate is known to uncouple mitochondrial oxidative phosphorylation. Since the viability of pyruvate-kinase-deficient reticulocytes depends on ATP generated by mitochondrial metabolism, this study examined the effects of salicylate on erythrocytes deficient in pyruvate kinase. When deficient erythrocytes from patients with severe hemolysis were incubated with salicylate (2 to 30 mg per deciliter), there was a marked decrease (25 to 75 percent) in ATP. In addition, this drug-induced ATP depletion produced cell potassium and water loss, and the normal oxidant responsiveness of the hexose-monophosphate shunt was blunted. Since these cellular abnormalities are associated with accelerated hemolysis in vivo, the data suggest that aspirin therapy may aggravate hemolysis in patients with pyruvate kinase deficiency whose erythrocyte manifest sensitivity to salicylate in vitro.


A controlled trial of multiphasic screening. A clinical controlled trial was designed to determine the impact of Automated Multiphasic Health Testing on morbidity and attitudes. Three strata comprising 574 families (lower-income group enrolled in health maintenance organization, lower-income not enrolled in such a project, and a middle-income group employed by a utility company) were interviewed to obtain information on utilization, morbidity, health status, and attitudes. Sixty percent of adults in each stratum were then screened. All families were interviewed again one year later. The only significant difference found between screened and non-screened subjects was an increase in nights hospitalized for screened subjects. Physicians were interviewed to determine what abnormalities were found and what treatment was required for project and privately referred patients of these physicians. Previously unknown abnormalities prompted retesting for confirmation in only 28 per cent of the cases and even less often led to treatment.


Grief response of parents after referral of the critically ill newborn to a regional center. Attitudes, feelings, and behavior were studied in 101 mother-father pairs whose critically ill newborn infants survived after referral from the hospital of birth to a regional neonatal intensive-care unit for special care. As measured by an anticipatory-grief score, most parents experienced grief reactions similar to those whose infants do not survive the newborn period. The level of anticipatory grief did not appear to be associated with severity of infant illness as determined by the need for respirator therapy or major surgical procedures. The fathers reported drastic alteration in daily activity while wife and infant were hospitalized in separate facilities, and they assumed a central role in maintaining family stability during the crisis. These data suggest that an organized family-support program could play a prominent part in maintaining family stability during the delivery of newborn intensive care.


Thyroid cancer occurring as a late consequence of head-and-neck irradiation. Evaluation of 1056 patients. From January 1 to September 30, 1974, we examined 1056 of 5266 subjects (20.1%) who had received therapeutic irradiation primarily for infections and inflammatory disease of the upper respiratory tract at our institution during the 1940's and 1950's. The tonsillar and nasopharyngeal region was the treatment site in 85% of those examined. Palpable nodular thyroid disease was found in 16.5%, and nonpalpable lesions were detected by 99m Tc pertechnetate thyroid imaging in an additional 10.7%, for a prevalence of nodular disease of 27.2%. Operation on 71% with nodular disease revealed thyroid cancer in 33% (60 of 182). Preliminary analysis for potential risk factors suggests a correlation between radiation exposure and the presence of thyroid nodules (P less than 0.001). These findings indicate that nodular thyroid disease, both benign and malignant, continues as a major health problem for at least 35 years in exposed subjects.


Protein patterns of brush-border fragments in congenital lactose malabsorption and in specific hypolactasia of the adult. Brush-border membrane proteins of the small-bowel mucosa were separated on polyacrylamide gels from intestinal biopsy specimens obtained from four children with congenital lactose malabsorption and from two adults with specific hypolactasia. In three patients with the congenital type of lactase deficiency the protein band corresponding to brush-border lactase was reduced in intensity, but was never completely absent. No difference in gel patterns was detected when this pattern in congenital deficiency was compared to that obtained from the two patients with adult-type selective hypolactasia. In one patient with congenital lactose malabsorption the protein band corresponding to lactase activity was not detectable. The findings suggest that the mechanisms leading to low lactase activity in the congenital and adult forms of lactose intolerance are similar.


Lung function and risk of myocardial infarction and sudden cardiac death. In a serach for risk factors for myocardial infarction and sudden cardiac death, the mean total vital capacity as measured at multiphasic health checkups was lower in persons who later had a first myocardial infarction than in risk-factor-matched controls (3.17 vs. 3.29 liters, 395 pairs, P less than 0.05) and non-risk-factor-matched controls (3.16 vs. 3.41 liters, 401 pairs, P less than 0.001). Findings were little affected by age and height adjustment and were similar for sudden cardiac death. The first-second vital capacity was also inversely related to later development of these conditions, but the ratio of that measurement to total vital capacity was not. Heavy smoking, productive cough, exertional dyspnea and cardiac enlargement were associated with diminished total capacity. However, exclusion of subjects with these findings did not reduce the predictive value of total vital capacity. Diminished vital capacity deserves continued attention as a possible coronary risk factor. Its relation to subsequent coronary events is not well explained.


Effect of ketosis on respiratory sensitivity to carbon dioxide in obesity. We investigated whether the respiratory defect in the obesity-hypoventilation syndrome might respond to dietary manipulation. The effects of hypocaloric ketogenic regimens on the ventilatory response to carbon dioxide were studied in a manner excluding changes in weight or thoracic mechanics as factors. Six obese subjects with hyporesponse (less than 1.1 1/min/mm Hg) and 12 with normal response were fasted or given a diet containing 400 kcal per day of protein. During ketosis carbon dioxide response more than doubled in those with hyporesponse (0.8 +/- 0.1 to 1.8 +/- 1/min/mm Hg, P less than 0.05) but was unchanged in those with normal response. This improvement could not be accounted for by changes in weight, pulmonary function, pH or degree of ketosis between the two groups. However, a significant positive (r = 0.70; P less than 0.001) correlation between ketone-body concentrations and carbon dioxide response was observed in subjects with hyporesponse. These results indicate that depressed sensitivity to carbon dioxide in obese patients can be increased by dietary manipulation.


Prevalence of clinical mitral-valve prolapse in 1169 young women. Eleven hundred and sixty-nine young women were prospectively examined for the presence of mitral-valve prolapse as manifested by midsystolic non-ejection click or late systolic murmur (or both). Of the 1169 women 74 (6.3%) had physical findings consistent with mitral-valve prolapse. Sixty-eight of the 74 (92%) had midsystolic non-ejection click, and in 57 the click was accompanied by a late systolic murmur. In six (8%) only a late systolic murmur was heard. Echocardiography on all patients with clinical diagnosis of mitral-valve prolapse showed patterns of prolapse in 60 of 74 (81%). Fourteen (19%) had negative echocardiograms. We conclude that mitral-valve prolapse is clinically present in approximately 6.3% of otherwise healthy young women.


T4 gene 32 protein model for control of activity at replication fork. Limited hydrolysis of gene 32 protein by various proteinases results in the production of three stable cleavage products. Two of these products show an affinity for native T4 DNA cellulose that the uncleaved protein does not exhibit. A model for proteolytic cleavage and for the total unwinding of DNA in advance of the replication fork is discussed in terms of this unusual binding affinity.


Body weight, diet and home range area in primates. Primates show a strong positive relationship between body weight and home range area. Dietary habits also influence home range area. Folivorous primates occupy smaller home range areas for their body weight than do frugivores and omnivores. Primates generally require smaller home range area per individual than solitary terrestrial mammals, but primates living in social groups have much larger total home range than individual solitary mammals. This trend may necessitate higher expenditures of energy in food-gathering or modifications in movement patterns.


Stable nuclear activation dependent on a protein synthesised during oogenesis. A protein synthesised during oogenesis seems to be essential for the activation, during blastulation, of the nuclear genes essential for gastrulation and organogenesis. Nuclear transplantation experiments show that this interaction between the protein and the blastula nucleus produces a heritable state of nuclear activation.


Developmental shifts in the synthesis of heterogeneous nuclear RNA classes in the sea urchin embryo. Three molecular classes with different properties can be distinguished in the heterogeneous nuclear RNA (HnRNA) of sea urchin embryos. The relative proportions of these classes, which we have previously designated alpha, beta and gamma HnRNA, undergo marked changes during development from morula to early gastrula. Such changes suggest the existence of more than a single HnRNA function, as well as specific roles for different HnRNA classes in embryonic development.


alpha-Chain contacts in the polymerisation of sickle haemogloblin. Five new double-mutant haemoglobins composed of betaS chains and alpha chains with different substitutions, which are located at the surface of the tetramer, have been prepared. Although all the hybrids are more soluble than deoxyhaemoglobin S, the individual differences between these molecules make it possible to evaluate several regions on the alpha chains for intermolecular contacts in the polymerisation of deoxyhaemoglobin S.


Sequence of promoter for coat protein gene of bacteriophage fd. The nucleotide sequence in the promoter region for the coat protein gene of phage fd has been determined. This sequence contains an endonuclease R-Hha cleavage site at the fifteenth nucleotide upstream from the RNA start site. Cleavage results in loss of promoter function. Comparison with the sequence of another fd promoter indicates that the longest sequence common to both was TATAAT in the region in which RNA polymerase forms a stable initiation complex.


[Chronic leukemia coexisting with hypophyseal tumor]. The author describes a case of hypophyseal tumor coexisting with chronic leukaemia. It is suggested that both these processes coexisted from the very beginning of the disease. Development of hypothalmo-hypophyseal system failure was due to the presence of hypophyseal tumour while intensification of these manifestations in the last stage of the disease was caused by the presence of leukaemic changes in the central nervous system.


[Diagnostic difficulties in brain strokes in the light of personal observations]. The authors report a clinico-neuropathological analysis of 350 case records and autopsy protocols of patients dying from stroke in the years 1962-1966 at the Department of Neurology of the Grochów Hospital in Warsaw. Full agreement of clinical diagnosis and autopsy diagnosis was found in 314 cases while in 36 cases (about 10%) the clinical diagnosis was not correct. The authors believe that the diagnostic difficulties encountered by clinicians are due frequently to a complex pathological mechanism of vasogenic lesions in the brain and frequency of encephalomalatic foci found in the same patient beside haemorrhagic lesions. In the present material 116 (33%) such cases have been found.


[Venous blood concentration of pyruvates in patients with stroke]. The concentration of pyruvate in the venous blood of 31 patients with stroke was determined by the enzymatic spectrophotometric method. The pyruvate concentration was raised on the 1st, 3rd and 10th days after stroke and this increase was statistically significant. Pyruvate concentration changes in venous blood were associated with severe clinical condition of the patients.


[Cathemnesis of patients with myasthenia]. Fifty patients with myasthenia were followed up, including 26 surgically treated cases (thymectomy) and 24 conservatively treated ones. Improvement was obtained after thymectomy in 10 cases (73%) and in 12 (50%) conservatively treated cases. Sixteen patients died, including 6 (23%) treated surgically and 10 (41.6%) treated conservatively. Good results of surgical and conservative treatment were observed in cases with mild or moderately severe course. In severe cases of myasthenia (with respiratory disturbances) surgical and conservative treatment was ineffective. Thymectomy should be carried out early before appearance of respratory failure.


[EEG pattern during treatment of parkinsonism with L-dopa]. The authors studied the dynamics of EEG changes in 27 patients treated with L-dopa. The records obtained before treatment were compared with those made during treatment and with the clinical manifestations. In 8 cases the EEG pattern was normal before treatment and 6 of them improved (three-fourths of this subgroup). In 19 cases the EEG pattern was abnormal and 10 of them improved (about 50%). Some intensification of temporal episodic complexes in EEG records was observed during treatment without concomitant changes of clinical manifestations. In 2 cases with slowed down background activity in initial records psychic disturbances of hallucinatory obnubilation type developed requiring withdrawal of treatment. This psychotic reaction was characterized in EEG with increased intensity of generalized slowing down of EEG activity.


[Direct magnification technic as a method of further improving the diagnostic value of cerebral angiography]. The authors report an evaluation of own results obtained using a technique of direct magnification which is a trial of further improvement of the diagnostic possibilities of cerebral arteriography. In the light of personal experiences and available literature the authors express the view that introduction of this method, especially in connection with traction, will increase significantly the possibility of diagnosis of various pathological processes.


[Post-traumatic petroso-nasal cerebrospinal fluid fistula]. The authors present five cases of posttraumatic petronosal fistulas. The stress the rarity of these cases, their anatomo-pathological aspects, the pathophysiological consequences of the osteo-meningeal fissure and the necessity of the neurosurgical treatment.


[Retinal changes in subacute sclerosing panencephalitis]. In a 12-year-old boy with histologically confirmed subacute sclerosing panencephalitis changes resembling chorioretinitis were found in the peripheral part of the left retina. Fluorescein angiography demonstrated signs of atrophy of pigmented epithelium. On the basis of pertinent literature the authors suggest that in this disease retinal involvement may precede neurological manifestations. It would be interesting to try whether therapy applied in this early stage would be effective.


[Subarachnoid hemorrhage from ruptured aneurysm in the course of pregnancy]. The authors report a case of subarachnoid haemorrhage from a ruptured aneurysm of the left internal carotid artery at the site of branching-off of the ophthalmic artery in a patient with advanced pregnancy. Indications and contraindications to surgical treatment in pregnancy are discussed. The case and follow-up are described.


[Diagnosis of 3-level lumbar nucleus pulposus prolapse]. Clinical investigations and plain film of the spine are not sufficient for diagnosis of three-level lumbar nucleus pulposus prolapse. Contrast investigations, especially radiculography with television monitoring, are particularly suitable for demonstration of multiple prolapses. In a material of 730 cases two-level prolapse was found in about 12% of cases and three-level prolapse in about 0.5% of cases and this suggests that radiculography should be carried out routinely before each operation for lumbar nucleus pulposus prolapse.