Temporal bone pathology in an active case of glue ear. A child aged 3 1/2 died from a cardiac condition after many and prolonged antibiotic courses: bilateral glue ear had been treated for the previous 18 months. Histopathology showed cholesterol granulomata in the mastoid air cells, with evidence of old hemorrhage, and of former inflammation of bone. The exudate was histiocytic with some giant cells. An 'orange spot' on the tympanic membrane was hyperaemic middle-ear mucosa, heavily infiltrated by plasma cells, lymphocytes and histiocytes. There was no evidence of hypersecretion. Some of the most abnormal areas were around the stapedial niche and the round window.


Loss of taste in the elderly: sex differences. The sensation of taste was tested in 280 normal people of all ages and both sexes. The sensitivity for the basic tastes decreased with increasing age, but more in men than in women; there was no sex difference in people under the age of 40. The different smoking habits of men and women did not explain this finding. It is suggested that there is a sex-specific decrease in the taste sensitivity with aging.


Late voice function after surgical injury to the recurrent nerve. In the period 1960 to 1970, a total of 213 patients underwent subtotal thyroidectomy for benign cervical toxic goitre. Postoperatively, immobile vocal cord indicating paralysis of the recurrent nerve was found in 17 patients. In 8 patients, immobility of the vocal cord was permanent. Seven of the 17 patients received voice training which was initiated within 3 weeks after operation. After a period of 5-10 years, on an average 8 years, the 17 patients had a clinical and a comprehensive objective examination of the voice function comprising stroboscopy, electroglottography, phono-oscillometry, voice range, phonation time, peak-flow and pitch. Only a few complaints were ciliated whereas the objective examination of the voice function revealed abnormal findings in all but one patient. The findings were less abnormal in patients who had received early voice training. It is concluded that despite abnormal objective findings, all 17 patients found their voice function satisfactory. Moreover, early voice training seemed to offer a fair chance of minimizing late voice problems, whether the paralysis was permanent or transitory.


Irradiation-induced changes in human salivary glands. Salivary tissue shows inflammatory changes, atrophy, replacement fibrosis, marked pleomorphism and atypia of the acinar epithelium and oncocytic metaplasia in the months following irradiation. The ductular epithelium undergoes squamous changes and within the ductular lumina, secretions become inspissated. The underlying pathogenetic mechanisms for these late irradiation induced changes may be the combination of a direct irradiation effect on acinar epithelium in association with post-obstructive inflammation and ischaemia, secondary to irradiation-induced endarteritis; however, these morphological changes observed may only be the result of an unusual repair phenomenon that salivary tissue is known to go through after any form of noxious stimulation. These histological alterations may lead to a possible misdiagnosis of malignancy in surgical specimens.


The place of cryosurgery in the treatment of subglottic angiomas of the infant. The treatment of subglottic angiomas of the infant is not clear since radiotherapy was rejected. Tracheotomy is very often indicated. Spontaneous recovery of angioma may be hoped for, but it is slow. Cryotherapy with liquid nitrogen using a 2.5 mm cryoprobe has cured, in a few stages, 3 cases. It has to be employed carefully.


Electrocochleographic changes in acoustic neuroma: some experimental findings. Reversible experimental lesions were produced in the central end of the cochlear nerve at the IAM of guinea pigs by various procedures, including the instillation of KCl (0.1 or 0.01 M). As a result the usual diphasic AP waveforms seen in guinea pigs (when click stimuli are used) were transformed into monophasic, widened negative waves. This change, attributed to a neural block, was reversible, e.g. when the instilled KCl was dispersed by irrigation with normal saline. It is suggested that the widened monophasic negative AP's observed at ECochG in cases of acoustic neuroma or similar lesions, are produced in this way.


Congenital malformation of the feet with low body height. A new syndrome, caused by an autosomal dominant gene. Among 75 members of a Danish family, 12 were found with a syndrome not previously described. Clinically, the syndrome consists of low body height and rigid flat feet, with weight-bearing pain in the feet. Radiologically, the deformation of the feet is a medial synostosis between the talus and the calcaneus combined with ankle joint dysplasia. The cause of the syndrome is most probably an autosomal dominant gene with complete penetrance. No linkage was found of the gene to 18 marker genes.


Short stature, craniofacial dysmorphism and dento-skeletal abnormalities in a large kindred. A variant of K.B.G. syndrome or a new mental retardation syndrome. A possibly new mental retardation syndrome is described in a large family. The major features of the syndrome are: short statue, craniofacial dysmorphism and dento-skeletal abnormalities. The mode of inheritance of this syndrome appears to be autosomal dominant with a variable degree of expressivity. The possible similarity to another autosomally dominant inherited mental retardation syndrome, "the K.B.G. syndrome" as described by Hermann et al. (1975), is discussed.


Cytogenetic study of 10 cases of infectious mononucleosis. Cytogenetic analysis of 10 cases of infectious mononucleosis has revealed increased damage in the form of chromosome breakage and aberrations typical of viral infection, but in addition a few cells were consistently found to harbour a deleted number 22, similar tsponse to the mitogen phytohaemagglutinin is suggested. This inhibitor appears to have a reversible action on the patient's own lymphocytes but no inhibitory effect on control lymphocytes.


C-bands in seven cases of accessory small chromosomes. The C-bands of two cases of familial, genetically inactive, accessory small chromosomes and five cases of genetically active chromosomes were examined. Inactive chromosomes consist of constitutive heterochromatin and satellites only. In active chromosomes, euchromatin was present. These chromosomes contained two, one or no C-bands, although all these chromosomes were morphologically monocentric. C-banding is more informative than other banding methods for this category of chromosomes.


Agenesis of the corpus callosum, infantile spasms, spastic quadriplegia, microcephaly and severe mental retardation in three siblings. A sibship consisting of three siblings, one male and two females with unrelated parents, showed a clinical syndrome including: infantile spasms with hypsarrhythmia, microcephaly, severe mental retardation and spastic quadriplegia. The pneumoencephalogram performed in two sibs showed agenesis of the corpus callosum and aqueductal stenosis with tri-ventricular dilatation. The disorder did not show a progressive course with deterioration of mental and neurologic functions. No biochemical or cytogenetic defect could be identified. Complement fixation for cytomegalovirus was negative. This syndrome complex is probably inherited as an autosomal recessive trait. The clinical and the genetic aspects of the syndrome are discussed.


alpha-l-Fucosidase of human skin fibroblasts and amniotic fluid cells in tissue culture. Cultured amniotic fluid cells had a higher level of alpha-L-fucosidase than skin fibroblasts. The early passages of amniotic fluid cells had a higher activity than later passages, whilst skin fibroblast activity was unrelated to passage. For both cell types alpha-L-fucosidase activity fell on subculture, rising again at confluency.


Meiotic consequences of an intrachromosomal insertion of chromosome No 1: a family pedigree. In three generations of the proband's patrilineal relatives, 14 subjects were found to be carriers of a "shift" insertional chromosome No. 1 (46XX or XY, ins(1)(p32q25q31)). The proband and three female relatives, who were mild to moderate mental retardates with minor congenital anomalies, were trisomic for the insertional segment, (1)q25q31. Another subject, who was a markedly immature female abortus with congenital abnormalities, was found to be monosomic for this same chromosomal segment. The cytogenetic evidence suggests that each of these unbalanced recombinant progeny was the result of a single crossing over in the noninsertional loop of a paternal pachytene bivalent of the balanced insertional chromosome No. 1.


Translocation Y/5 resulting in Cri du Chat syndrome. A case of 45,X,del(5)(p14/45,X,t(Y;5)(q11;p14) mosaicism is described. The patient displays the clinical features of the Cri du Chat syndrome, together with gross malformation of the distal left arm. The presence of male sex development is consistent with the location of factor(s) controlling the male sex determination in the paracentromeric area of the Y chromosome.


Cystinuria and mental deficiency.

Cystinuria and mental deficiency. Several studies have shown that the incidence of cystinuria in mentally retarded populations is higher than it is in the general population. The present study found that a group of cystinurics did not differ significantly in their intelligence from their normal siblings or intelligence test norms. Since cystinuria is a heterogeneous disease, the findings of the present study could be reconciled with previous findings by supposing that only certain genotypes for cystinuria lead to mental retardation.


Cystic fibrosis: studies with the oyster ciliary assay. Bioassays using ciliary systems have detected a factor or factors in cystic fibrosis (CF) sera and tissue culture medium derived from CF cells. The typical shortcomings of an assay measuring biological activity have been studied, and the means to overcome the weaknesses of the oyster gill cilia assay have been established. The presence of the cystic fibrosis mucociliary inhibitor (CFMI) in experimental fractions may be determined by accepting data from only those assays in which authentic CF and normal (non-CF) fractions give defined reactions, by measuring the reaction of each sample at least three times, and by examining each experimental sample at a protein concentration greater than the minimum established in this study. The relative concentrations of the CFMI present in the first steps of purification of serum and medium have been calculated in terms of units of inhibition. Generally, the units of inhibition present in serum and medium fractions from heterozygotes are close to one-half of that in fractions from homozygous sources. Analogous fractions concentrated from a normal (non-CF) source never inhibited mucociliary activity, even when tested at nearly 100 times the CF concentration. Ciliary assays utilizing oyster gills are essential for monitoring fractionation procedures aimed at purifying the CFMI, and have been shown to be capable and reliable enough to do so.


Central nervous system arteriovenous malformations in multiple generations of a family with hereditary hemorrhagic telangiectasia. Hereditary hemorrhagic telangiectasia is described in four generations of a kinship. The family is unique in that three generations manifest central nervous system vascular disease, which was pathologically confirmed in two generations. Genetic linkage was not identified for 32 genetic markers studied. The literature is reviewed for patients with central nervous system arteriovenous malformations and hereditary hemorrhagic telangiectasia. The pathogenesis of the disease is discussed, and therapeutic modalities are considered.


Persistent glomerulonephritis following the haemolytic-uremic syndrome. Immunopathological and morphological studies. Immunopathological and ultrastructural studies were carried out on kidney biopsies of eight children with a persistent nephropathy (PN) following the haemolytic-uremic syndrome (HUS). Significant amounts of in vivo-bound immunoglobulins and C3 were demonstrated by immunofluorescence methods in the glomeruli of all the cases, with a nodular pattern along the capillary walls. In four cases studied, C1q and C4 were also demonstrated, with an identical distribution. Transmission electron-microscope studies revealed a marked thickening of the glomerular basement membrane, and the existence of an electron-dense material with an intramembranous and subepithelial localization. With the exception of one case, serum complement studies did not present major modifications. Coagulation studies reveal that alterations observed in acute HUS were not present in the PN. Results of the present study suggest that an immune mechanism of glomerular damage operates in the pathogenesis of the PN observed after HUS, leading to a normocomplementemic, chronic glomerulonephritis. Although a hypothetical antigen (or perhaps several antigens) remains to be demonstrated, immunofluorescence and electron-microscope studies suggest the deposition of immune complexes in the renal lesions.


The detection of circulating immune complexes in children with recurrent infections and their treatment with human immunoglobulins. In a study of thirty-nine children with recurrent infections, circulating antigens, either free or in the form of immune complexes, were detected in thirty. The ability of sera to inhibit the agglutination of latex by rheumatoid factor or the C1q component of complement was used as a test for the presence of immune complexes. The children were treated by three injections of the same preparation of human immunoglobulin as that used for the serological tests, and a marked and sustained improvement in twenty-one patients was observed. In nineteen of these, circulating antigens reacted in vitro with antibodies in the immunoglobulin preparation, whereas of the eighteen children who did not improve with treatment, the sera of thirteen failed to react in vitro with the immunoglobulin preparation.


Quantification of the lymphocytic infiltrate in jejunal epithelium in giardiasis. The intraepithelial lymphocytes of the jejunal mucosa from patients with giardiasis and from control patients were counted in coded serial sections. Patients with giardiasis and normal intestinal absorption and control patients who had lived and travelled in tropical areas had similar counts, which were higher than those reported for controls from temperate areas. Where giardiasis was accompanied by malabsorption of one substance the mean count was significantly higher than that of controls (P less than 0.02). In those patients with giardiasis and malabsorption of two or three substances the mean count was significantly higher than that of controls (P less than 0.02) and that of patients with giardiasis and normal absorption (P less than 0.05). After treatment, intraepithelial lymphocyte counts declined consistently in patients with malabsorption. An association between raised intraepithelial lymphocyte counts and malabsorption is indicated. The possible significance of this finding is discussed.


A test for antigen--antibody complexes in human sera using IgM of rabbit antisera to human immunoglobulins. A simple semi-quantitative test for soluble antigen--antibody complexes using characterized non-human reagents and permitting analysis of their constituents is described. The agglutination of immunoglobulin-coated latex particles by rabbit IgM antibodies to the immunoglobulin is inhibited by complex-containing sera. No inhibition is obtained with monomer immunoglobulins. Semi-quantitative measurement of complexes may be made by electronically counting residual unagglutinated latex particles. The new method of linking proteins to latex by DNP coupling permits the technique to be applied to all constituents of complexes; immunoglobulins, complement and antigens. A new method of decomplementing sera by EDTA-Sigma cell-IgG absorption allows analysis of sera without the false positives and false negatives other methods give. The test gave positive results for IgG complexes in most of twenty-four patients with SLE nephritis. IgA complexes were identified in a patient with Henoch-Schonlein purpura nephritis.


Absence of a receptor for fixed C3 on the hairy cells of leukaemic reticuloendotheliosis. By the use of a rosette test employing yeast particles coated with C3 activated by the alternative pathway, we have demonstrated that the hairy cells of leukaemic reticuloendotheliosis (LRE) do not possess a receptor for C3. It is also shown that hairy cells display a consistently lower percentage of rosette formation with ox EAC than with ox EA IgM and this is attributed to varying degrees of steric hindrance of IgM or incomplete coating by complement. Blocking with monomeric IgM confirmed this interpretation. These results are used to reconcile previously conflicting reports concerning the presence or absence of a receptor for C3 on the hairy cells of LRE, and to suggest that the disease is accompanied by a severe reduction of normal B lymphocytes.


Immunoglobulin levels in white and metis communities in Saskatchewan. Serum-immunoglobulin levels (IgG, IgM, IgA, IgD, IgE) have been studied in white and metis (Cree Indian) communities in Saskatchewan. The levels of IgG, IgA, IgD and IgE were higher in the metis than in the whites. Both IgG and IgM were higher in females than in males. IgG and IgA levels rose progressively with age. IgM levels rose rapidly during the first year to almost adult levels, and then fell gradually after the age of 30. IgE levels also rose rapidly during the first 3 years of life, were higher on average in children than in adults, and fell to adult levels at puberty. Low levels of IgA were associated with high levels of IgG; they were not associated with either high levels of IgE or an increase in the prevalence of asthma.


Enhancement of human lymphocyte responses to phytomitogens in vitro by incubation at elevated temperatures. Incubation of human lymphocytes with PHA or Con A at 39 degrees C for 3 days caused a consistent, statistically significant, increase in [3H]thymidine uptake, compared with cultures incubated at 37 degrees C. The responses were also significantly increased after 2 days of incubation, suggesting that hyperthermia not only enhanced, but also caused an earlier onset of the mitogen response.


In vitro cell response of Treponema pallidum-infected rabbits. II. Inhibition of lymphocyte response to phytohaemagglutinin by serum of T. pallidum-infected rabbits. Serum inhibitors of lymphocyte response to PHA were found in T. pallidum-infected rabbits. The humoral inhibitors could be detected as early as 10 days after infection and persisted for at least 6 months. The factors also suppressed the allogeneic lymphocyte response. Control, or normal, rabbit sera likewise contain serum inhibitors, but in much lower concentration. The detection of the humoral inhibitors depended on the susceptibility of the indicator lymphocytes. Cells of some rabbits were more sensitive to the inhibitors than others. In addition to serum inhibitors, lymphocytes of T. pallidum-infected animals seem to be impaired and responded to PHA less vigorously than cells of normal rabbits. The inhibitory activity is most likely the result of a complex group of substances with different physicochemical characteristics; some pre-exist and others are newly formed after infection. Problems associated with the detection of such inhibitors are discussed.


The effect of PHA-activated MN-cell supernatants on polymorphonuclear leucocyte function. The effect of PHA-activated mononuclear-cell (MN) supernatants on various polymorphonuclear-leucocyte (PMN) functions were assessed. Treatment of PMN with PHA-activated MN-cell supernatants resulted in greater electrophoretic mobility, indicating an increase in the negative surface charge. PMN directional motility was inhibited in the presence of active supernatants but was not affected by a pulse exposure of the PMN to these supernatants. Neither control nor active supernatants were chemotactic for PMN, but treatment of these cells with active supernatants produced an increase in their phagocytic activity, their ability to reduce NBT and in their glucose oxidation through the hexosemonophosphate shunt. Bactericidal capacity of these PMN was unaltered. Specific loss of leucocyte inhibitory factor (LIF) activity from supernatants of PHA-activated MN cells followed their absorption with PMN cells but not with human MN cells or guinea-pig peritoneal exudate cells. Furthermore, acquired inhibition of migration of the absorbing PMN was observed.


An experimental comparison of radioactive labels with potential application to lymphocyte migration studies in patients. The suitability of two radionuclides (99mTc, 111In) for labelling lymphocytes have been evaluated in rats by comparison with a standard method using 51Cr. For the study of lymphocyte migration in patients labelling with 111In-labelled oxine is clearly the most promising because both in vivo and in vitro it remains associated with lymphocytes and the labelled cells migrate normally into lymphoid tissues. The physical characteristics of 111In are also favourable. Not only does 99mTc rapidly dissociate from lymphocytes but also it compromises their ability to recirculate from blood to lymph.


The mechanism behind the effect of ALG on platelets in vivo. Antilymphocyte globulin (ALG) and antiplatelet globulin (APG) were injected in dogs whose autologous platelets were labelled with 51Cr. APG injection resulted in almost complete and irreversible disappearance of labelled platelets. ALG produced thrombocytopenia of the same degree, but this was to a large extent reversible. After injection of ALG the platelets were reversibly trapped in the lung during the time when platelet count in peripheral blood was low. Such trapping was not seen after administration of APG. This suggests an antiplatelet mechanism of ALG quite different from that of APG. Platelet-absorbed ALG and non-platelet-absorbed ALG produced thrombocytopenia of the same degree and pattern, making it less likely that the thrombocytopenia was caused by specific platelet antibodies. Also platelet-absorbed APG induced thrombocytopenia, but this was reversible and 'ALG-like'. The mechanism behind the platelet reaction after an ALG injection is well explained in terms of complement C3 adherence and/or Fc receptor-induced aggregation.


Sensitivity changes in guinea-pig atria and ileum following subacute administration of dyflos. 1. Subacute administration of dyflos to guinea-pigs (1.2 mg/kg, s.c., daily for 10 days) led to the development of subsensitivity to carbachol in the ileum but not in the electrically stimulated left atrium. 2. Atria from dyflos-pretreated animals became supersensitive to acetylcholine but the ileum became subsensitive to this agonist despite marked inhibition of cholinesterases. The degree of subsensitivity was less than that for carbachol. 3. Subsensitivity also developed to histamine and was of a similar order to that observed for carbachol supporting the suggestion that subsensitivity is a nonspecific post-receptor mechanism. 4. Other changes which occurred in the ileum, together with the increase in the EC50 value to agonists were an increase in tissue mass, an increase in the slope of the concentration-response curve to agonists and an increase in the maximal response to agonists.


Modifying effect of bradykinin on motor activity in the guinea-pig gall bladder. 1. The interaction of bradykinin and cholecystokinin preparations was investigated on the guinea-pig isolated gall bladder. Bradykinin (1-100 ng/ml) induced dose-dependent contractile effects which were considerably smaller than those produced by cholecystokinin octapeptide. Bradykinin in a low concentration (1.0 ng/ml) caused a significant increase of the contraction induced by cholecystokinin octapeptide (P less than 0.001) and natural cholecystokinin-pancreozymin (P less than 0.01), and also augmented the effects of acetylcholine on this preparation. Therefore these effects are probably not specific for cholecystokinin.


The effects of sodium chloride, urea and mannitol on the permeability in vitro fo rat papillary collecting ducts to THO, 14C-urea and 22Na. 1. The diffusional permeabilities of collecting duct membranes to THO, 14C-urea and 22Na+ have been measured at different concentrations of urea, NaCl and mannitol. 2. In the absence of urea in perfusate and bath or in its presence in low concentrations, the diffusional permeability to urea was 2.0 (s.e.m. = 0.15, n = 58) micrometer s-1, compared with 0.87 (s.e.m. = 0.06, n = 29) microgram s-1 when 200 mmol/l urea was present. The permeability of the collecting ducts to THO or Na+ was not affected by the different urea concentrations. 3. High concentrations of sodium chloride increased the diffusional permeability of collecting ducts to water and urea but did not affect the diffusional permeability of the collecting duct to Na+. 4. Mannitol had effects similar to those of sodium chloride. 5. In all media tested there was an increase in THO and urea permeability when supramaximal amounts of antidiuretic hormone were added. The increases in the various media for each substance were similar, despite widely different starting permeabilities. 6. The results suggest that solutes and water move across collecting duct epithelium by several pathways that respond differently to various stimuli.


Effects of acetylcholine on the frequency-force relationship of the isolated dog atrium. 1. The effects of acetylcholine on the frequency-force relationship in isolated atria of the dog were investigated in spontaneously beating and electrically paced preparations, which were suspended in a bath perfused with arterial blood from a carotid artery of a heparinized donor dog. 2. The developed tension at low frequencies of stimulation was less suppressed than at higher frequencies by an infusion of a relatively low dose level (1-2 microgram/min) of acetylcholine. At higher doses (4-10 microgram/min), acetylcholine suppressed the tension development at any given frequency.


Evaluation of drug-induced reno-renal vasomotor reflex in the dog. 1. Renal arterial infusions of endogenous vasoactive compounds were administered, and elctromagnetic flow probes were used to measure simultaneous ipsilateral and contralateral renal blood flow. 2. The expected ipsilateral renal blood flow changes resulting from infusions of acetylcholine, noradrenaline, angiotension II, bradykinin and PGE2 were observed. There were no transient, phasic or sustained contralateral renal blood flow changes. 3. These results suggest that a previously hypothesized reno-renal vasomotor reflex communication does not exist. The discrepancies between these present studies and previous ones proposing such a reflex may be due to the methods chosen for measurement of renal blood flow.


A comparative study of antipyrine pharmacokinetics in saliva and plasma using a colourimetric method of antipyrine analysis. 1. Half-life, apparent volume of distribution and metabolic clearance rate for antipyrine elimination were reliably estimated from either plasma or saliva samples. 2. Pharmacokinetic analysis of antipyrine from saliva utilizing a simple and sensitive colourimetric technique provided a convenient method for assessing the activity of hepatic microsomal drug-metabolizing enzymes.


Effects of ultrafiltration on solute clearances in parallel plate dialyzers. Clearances of small and large solutes were measured at increasing transmembrane pressure in 3 types of parallel plate dialyzers. Both laboratory and clinical studies were performed. As in previously reported studies in coils, diffusive transport appears to decrease as transmembrane pressure increases. This may reflect blood channel widening, bath channeling, and/or membrane masking by mesh support. For small solutes, decreases in diffusive transport were enough to offset gains by solvent drag and total clearances decreased. In some studies, decreases in small solute clearances with increasing ultrafiltration were large enough to compromise dialysis efficiency.


IgA nephropathy: a syndrome of uniform morphology, diverse clinical features and uncertain prognosis. Isolated glomerulonephritis with mesangial IgA deposits was the most common single finding encountered in a large biopsy series in an Australian community and was found in 50 patients, 18% of those presenting for the investigation of primary glomerular disease. A uniform histopathological picture of mesangial enlargement, with or without focal and segmental features was present. A tendency to progression was suggested by the frequent presence of glomerulosclerosis, interstitial scarring and vascular hyalinization. Because of the uniform histological immunofluorescence and ultrastructural appearances, the term IgA nephropathy has been used for this condition. The clinical picture, however, was heterogenous. Presenting symptoms included macroscopic hematuria (34%), proteinuria (32%) acute nephritis (10%), nephrotic syndrome (6%), malignant hypertension (8%), acute renal failure (6%) and chronic renal failure (4%). There was a striking correlation of increased blood pressure and decreased renal function with increasing age. While the period of follow-up was too short to assess individual patient data, a gradual and progressive decrease in renal function over several decades is suspected in patients with this condition.


Depressant action of acetate upon the human cardiovascular system. The effect of regular hemodialysis (HD) with dialyzate containing acetate was evaluated in 20 patients. After dialysis, a significant increase in limb blood flow was found (P less than 0.01) while the mean arterial blood pressure remained unchanged indicating a significant decrease in peripheral vascular resistance after HD (P less than 0.01). Cardiac function was evaluated using the ratio of the preejection period to left ventricular ejection time (PEP/ET); this value showed a significant increase after HD suggesting depression of cardiac function (P less than 0.001). The study was repeated substituting bicarbonate for acetate in 13 of the 20 patients. Under these conditions, limb blood flow and peripheral vascular resistance showed no significant change though mean arterial blood pressure decreased significantly (P less than 0.01). The ratio, PEP/ET, showed a significant increase after HD (P less than 0.01), but the value was significantly lower than that found after HD with dialyzate containing acetate (P less than 0.05). Changes in the serum levels of calcium, potassium, pH and body weight could not explain the differences found after HD with the two kinds of dialyzate. The results of the present study suggest strongly that acetate exerts a depressant action on the cardio-vascular system.


Hemolysis and blood loss in children with chronic renal failure. Erythrocyte life span was determined in 19 children with chronic renal failure on conservative treatment and in 12 children on regular hemodialysis. Erythrocytes were labeled with 111Indium. Blood loss was measured using a special counting chamber. Erythrocyte life span decreased with increasing blood urea nitrogen. Blood loss into the intestine and into the dialysis equipment was found to be a major cause for anemia of children with chronic renal failure. Daily intestinal blood loss amounted to 6 ml/m2 BSA on conservative treatment and 11 ml/m2 on hemodialysis. Mean blood loss in the dialysis equipment was 8 ml/m2 per dialysis, almost half being lost in the connecting tubing systems.


Plasma drug level monitoring in pregnancy. During pregnancy a number of continuously changing circumstances exist which might be expected to modify the relation between plasma drug levels and drug dosage. Alimentary tract motility may be decreased, the distribution of many drugs may be altered, glomerular filtration rate is greater and biotransformation capacity may be changed as pregnancy  advances. However, relatively little has been published on the monitoring of plasma drug levels during pregnancy. It has been established that, in the presence of constant drug doses, plasma levels of phenytoin, phenobarbitone and certain other anticonvulsants tend to fall during pregnancy and rise again during the puerperium. Plasma lithium and possibly digoxin levels also fall relative to drug dose as pregnancy progress, and rise again in the puerperium. While the changes in lithium and digoxin levels are probably chiefly due to increased rate of glomerular filtration during pregnancy, the altered anticonvulsant requirement is more likely to depend mainly on an increased rate of biotransformation. Anticonvulsant plasma levels should be monitored regularly from the outset of pregnancy and more frequently after birth.


Pharmacokinetics of 5-fluorouracil: inter-relationship with biochemical kinetics in monitoring therapy. The major difficulty in using pharmacokinetic concepts for monitoring individual therapy with 5-fluorouracil is based on the mostly intracellular location of the active nucleotide metabolites of 5-fluorouracil with no clear correlation of plasma levels of the drug. In addition, the basic biochemical mechanism of 'thymine-less cell death' following inhibition of de novo thymidylate synthesis by 2'-deoxy-5-flurouridine 5'-monophosphate (FdUMP) is poorly understood, and only some of the biochemical determinants of therapeutic response to 5-fluorouracil are known. Individualised therapy with 5-fluorouracil requires an intergrated approach which should include methods of pharmacokinetics and biochemical kinetics. 5-Fluorouracil stands as an example for most of the pyrimidine and purine metabolites to which similar consideration apply in monitoring of cancer chemotherapy.


The role of ultrasound in the assessment and treatment of abdominal metastases from testicular tumours. The para-aortic region has been investigated with ultrasound in 95 patients with testicular teratoma seen in the testicular tumour unit between 1973 and 1976. The liver was assessed in 110 patients. The technique has provided useful and reliable information. Para-aortic ultrasound can provide more information than existing diagnostic methods and is particularly useful for defining the volume of metastatic nodal masses. Its role should be regarded as complementary to that of lymphography. Ultrasonography is particularly useful to the radiotherapist since it can define the volume and limits of the tumour and thus influence choice of therapeutic approach and radiation planning technique. Ultrasound is also valuable in the assessment of response to treatment and in monitoring the patient during the subsequent follow-up period.


Ascending uretero-pyelography in renal failure. Ascending uretero-pyelography has been carried out over a period of 13 years in 97 consecutive patients with undiagnosed renal failure. Sixty-nine were in a non-obstructive uropathy group while 26 had ureteric obstructions. There were two failures. Over 60% of examinations were performed under local anaesthesia, each examination taking an average of 20 min. There has been no mortality and two anaesthetic complications have been the only significant morbidity. Ureteric injury, urinary infection and renal function have all been investigated and recorded. Five per cent of patients developed urinary infection following AUP but without any major consequences. No significant ureteric injury occurred and no late sequelae were noted. Neither any reaction to contrast medium nor any further deterioration in renal function was observed; AUP was diagnostic in 46% of patients. In the remainder it ruled out obstructive uropathy and gave useful information about the kidneys, ureters and bladder. In experienced hands and with proper facilities AUP is safe and can be helpful in the diagnosis and management of patients in renal failure.


Pre-treatment 3H-TdR labelling of cervical biopsies: histology, staging and tumour response to radiotherapy. Pre-treatment data from tumour biopsies labelled in vitro with tritiated thymidine are reported for 54 patients undergoing radical radiotherapy by 137Cs or Cathetron 60Co intracavitary insertions plus external irradiation for carcinoma of the uterine cervix. Labelling indices were obtained ranging from 1.8 to 27.8%. No correlation was observed between mean labelling indices and the histological type of tumour or its degree of differentiation. Comparison of data obtained in this study with previously reported data for carcinoma in situ and invasive carcinoma indicate that with increasing clinical stage of the disease, a considerable lengthening of the potential doubling time of the tumour cells, from less than 1 to 8 days, occurs. The degree of vaginal spread of the tumour was directly related to the degree of parametrial involvement. The mean time taken for the vaginal component of the tumour to resolve following radiotherapy was related to its initial spread and the pre-treatment labelling index. The greater the spread of the tumour, the lower the labelling index and the longer the time taken for resolution. Up to 1 year following radiotherapy the incidence of locally recurrent, or metastatic disease was unrelated to the pre-treatment labelling index.


Spontaneous regression of metastases from testicular tumours. A report of six cases from one centre. In a review of the cases of testicular tumours treated at the Christie Hospital between 1961 and 1974 there are six cases with spontaneous regression of metastases, which are now reported. In this period, 827 cases of testicular tumour have been treated giving an incidence of spontaneous regression of 0.72%, which is considerably higher than previously reported. One of the cases appears to be pure seminoma; spontaneous regression of metastases from seminoma has not been reported previously.


Radiotherapy in the management of Kaposi's sarcoma in Nigeria. Although Kaposi's sarcoma is now known to be far more common in the black African than was originally thought, it is rare in Nigeria. Facilities for radiotherapy are not available in areas of Africa where this condition occurs frequently. Various chemotherapeutic agents have been used either singly or in combination, with different results. In the locally confined lesions, it is believed that radiotherapy has an edge over the use of cytotoxic drugs. Five patients were seen and treated with radiation at the Lagos University Teaching Hospital in five years. They were all males, adults and came from the southern part of the country. All had histological confirmation of their disease as well as full investigations. Their histories are briefly reported. Response to chemotherapy from the literature has been discussed in order to highlight similar peculiarities attending the use of radiation on the normal tissues of the limbs. Ten different dose--time relationships were used on the five patients and these were plotted on double log scale. The results show that good response to curative radiotherapy varies inversely with the duration of the disease.


Thyroid dysfunction following external irradiation to the neck for Hodgkin's disease in childhood. Thyroid function was studied in 32 patients who had received neck irradiation during childhood for Hodgkin's disease. All except one patient received a dose of 2500-3000 rad over a period of 19-25 days. In 12 patients lymphangiography was performed. Clinically all patients were considered euthyroid. One had a thyroid swelling which was cystic in nature. Five (16%) patients were biochemically hypothyroid, 17 (53%) were euthyroid with an elevated basal serum TSH concentration and a further seven (22%) were euthyroid with a normal basal serum TSH level but an augmented thyroid-stimulating hormone (TSH) response to thyrotrophin-releasing hormone (TRH). Only three (9%) patients had completely normal thyroid function tests. The basal serum TSH concentration and the peak serum TSH response to TRH were significantly greater in the patients who received neck irradiation and lymphangiography than in those who received neck irradiation alone. In addition the free thyroxine index decreased significantly as the time interval between treatment and study increased in the lymphangiography group. These data demonstrate that the normal thyroid gland is vulnerable to the damaging effects of external irradiation, and that the combination of neck irradiation and lymphangiography is more likely to result in thyroid dysfunction than is neck irradiation alone. Furthermore, in view of the deterioration in thyroid function with time, periodic clinical and biochemical assessment of thyroid function is clearly indicated.


Cranial isotopic section scanning.

Cranial isotopic section scanning. Some results of isotopic cranial section scanning are presented from a busy neurosurgical practice. Isotopes have been used for parenchymal lesions and also CSF pathway imaging. Comparisons with information yielded by other neuroradiological techniques have indicated that tomographic sections are a worthwhile addition to rectilinear isotope scans. In particular comparison with X-ray transmission (EMI) scans has confirmed the anatomical accuracy of the method and the two techniques have proved complementary in patient management.


Indications for contrast medium enhancement in computed tomography of the brain. The use of contrast medium enhancement in computed tomography almost doubles the duration of each examination. As the clinical demand is far greater than the scanning time available, it is desirable to use contrast medium with discrimination. The following indications are suggested for extended examinations with contrast: 1. Lesions shown by alternative neuroradiological investigations. 2. Local abnormality shown on plain scan. 3. Suspected posterior fossa lesions. 4. Suspected suprasellar lesions. In a retrospective review of 3000 patient examinations, 430 patients falling outside the above criteria had been given contrast medium. In only one patient in this latter group was an abnormality shown after contrast enhancement. In the other 429 patients, no additional information was obtained. These figures support the indications suggested for the use of contrast enhancement.


Epithelial (inverted) papilloma: a correlated radiological--histological study. The radiological and pathological features in 14 cases of epithelial papilloma are described. The typical radiological findings are a mass in the nares and sinus opacification, usually on the same side. Occasionally, extension of the mass into the nasopharynx is observed. Bone destruction may be present in epithelial papilloma, possibly due to pressure erosion. In the presence of carcinoma, bone destruction may be due to direct invasion.


Abdominal lymphography in thalassaemia major. The appearances are described of abdominal lymphography in seven patients with thalassaemia major. All were severely and chronically anaemic. An abnormal course of lymphatic channels was seen in only one case. Nodal filling defects were found in all patients, lying centrally and peripherally, in para-aortic and iliac glands. The findings correlate well with the microscopic features of lymph nodes removed at therapeutic splenectomy. These show haemosiderin deposition and foci of extramedullary erythropoeisis.


Radiodiagnostic signs in pseudoxanthoma elasticum generalisatum (dysgenesis elastofibrillaris mineralisans). The clinical symptomatology of patients suffering from pseudoxanthoma elasticum and the radiodiagnostic signs in four patients suffering from this disease have been reviewed. In these patients four groups of previously unpublished radiodiagnostic abnormalities were found. These are calcification of a number of ligaments; changes in the wall of brachiocephalic trunk, the right common, internal and external carotid arteries; fibro-osseous metaplasia of the long bones; dysplasia of the vertebrae. The authors believe that these changes are explicable by the general disorder of connective tissue and its derivatives which occurs in pseudoxanthoma elasticum.


Obscure stenosing aortitis and arteritis associated with perivascular lymphadenitis--combined angiographic and lymphographic evaluation. A series of eleven cases of an obscure occlusive type of aortitis and arteritis is reported. These are characterised by chronic nonspecific perivascular lymphadenitis and fibrosis, constricting the lumen of the vessels. Subsequent spread of the inflammatory process produces irreversible changes in the vessel wall. Timely excision of the nodes, release of fibrous strands and decompression of the vessels may result in a permanent cure; The inflammatory process is nonspecific in nature. The etiology is obscure and is subject to speculation. Tuberculous inflammation of the lymph nodes appears to be unlikely while filarial lymphadenitis is probable. The disease is not a primary panarteritis as observed in Takayusu's disease or allergic vasculitis. Males are predominantly affected and present invariably with clinical signs and symptoms of peripheral vascular obliterative disease of the lower extremities.


Computerised tomography and the liver.

Computerised tomography and the liver. Computerised tomography produces an excellent image of the liver. The author discusses the relevant technical factors such as the use of window levels and window widths, tissue attenuation values and filtering. The importance of the applied anatomy and the use of contrast agents are discussed and then the findings on computed tomography in clinical practice are presented. The lesions that can be visualised include cysts, abscesses, primary tumours, metastases, fatty liver, subphrenic abscess, dilated bile ducts and cholelithiasis as well as surrounding ascites. These appearances are described and illustrated.


The impact of CT scanning and ultrasonography on orbital diagnosis. New methods of soft tissue imaging have revolutionised the investigation of the orbit. The impact of CT scanning and ultrasonography is considered in relationship to established techniques including angiography. The importance of plain X-ray examination and conventional tomography is stressed for the exclusion of non-orbital causes of exophthalmos. In the orbit CT scanning is the best method of establishing the presence of a mass lesion; ultrasonography is useful principally for the investigation of optic nerve problems. Venography is still required in most patients to diagnose and establish the extent of a venous malformation in the orbit; it also has an important part to play in the diagnosis of inflammatory processes. Carotid angiography is now only required in patients with highly vascular orbital tumours, or with suspected arteriovenous anomalies. Plain X-ray examination, CT scanning and venography are regarded as the dominant investigations with conventional tomography, ultrasound, and arteriography playing a subsidiary role.


The intrapancreatic anatomy as an index of adequacy of pancreatic arteriography. Analysis of 100 pancreatic arteriograms in respect of intrapancreatic arteries shown has been performed. The results have been compared with Michels' classic series of 200 cadaveric dissections. Excellent correlation has been found. The degree of demonstration of small intrapancreatic arteries in our view is an index of the adequancy of pancreatic arteriography.


Aphthoid ulcers in Crohn's colitis.

Aphthoid ulcers in Crohn's colitis. Aphthoid ulceration is a strong indication and the earliest radiographic sign of Crohn's colitis. These small discrete ulcers were found by double contrast barium enema examination in 40 out of 91 patients with Crohn's colitis. Seen en face each ulcer appears as a central fleck of barium surrounded by a translucent halo set amidst a patch of normal mucosa. Their detection gives a more accurate assessment of the extent of disease. This information is required in order to plan medical or surgical treatment and can only be provided by meticulous double contrast examination or colonoscopy. Aphthoid ulceration has been demonstrated prior to the onset of bowel symptoms, and several years before the advent of severe colonic disease. The appearance of aphthoid ulcers in established quiescent disease has been observed to herald a relapse. The radiographic demonstration of the evolution of ulceration, which is illustrated, closely reflects what is seen on macroscopic examination of excised specimens and explains the characteristic patchiness and discontinuity of disease.


Localised giant pseudopolyposis secondary to ulcerative or granulomatous colitis. Pseudopolyps which represent polypoid oedematous tags, regenerating mucosal islands between ulcerations or heaped-up granulation tissue covered by epithelium, are a common sequela of ulcerative colitis and may also occur secondary to granulomatous colitis. Occasionally, a large discrete mass of pseudopolyps occurs simulating a villous-like or polypoid neoplasm and the term 'localised giant pseudopolyposis' has been applied to this phenomenon. In this paper the radiological appearances of localised giant pseudopolyposis secondary to ulcerative or granulomatous colitis are described and illustrated. The differential diagnosis is discussed and four new cases are added to eight previously reported in the literature.


The distribution of gastric ulcers: double contrast barium meal and endoscopy findings. One thousand consecutive double contrast barium meals and 424 consecutive upper gastrointestinal endoscopic examinations have been reviewed. 70 gastric ulcers were found radiologically in 56 patients and 82 gastric ulcers endoscopically in 70 patients. 55% of radiological and 53.6% of endoscopic ulcers were located in the mid or upper body of the stomach. The distribution is contrary to previous radiological findings with the traditional barium meal. Age did not seem to be a major factor. The double contrast meal and in particular the left anterior oblique view with the head elevated, display en face the lesser curve of the upper body around the cardia where many benign ulcers and carcinomas arise.


A comparative study of double contrast and single contrast barium meals with endoscopic arbitration in the diagnosis of peptic ulcer. The study compares the ability of a simple double contrast technique with our standard single contrast barium meal to diagnose peptic ulceration. Two hundred and six patients were randomly allocated to either examination. Endoscopy was used as the definitive diagnostic procedure. Deformity of the duodenal cap was more accurately detected by the double contrast technique (P less than 0.01). There was no significant difference in the detection rates for duodenal ulcer. False positive or false negative diagnoses of duodenal pathology were similar by both techniques. The incidence of gastric ulceration in the series was too low for statistical analysis.


The two-film barium meal in the exclusion of coeliac disease. Prospective experience over five years is described in assessing the two-film barium meal as a test for the exclusion of untreated celiac disease in children in order to try to make jejunal biopsy unnecessary. 287 meals were examined in children between 3 months and 10 years of age with a variety of gastro-intestinal symptoms and signs that might be attributed to celiac disease. From the two-film barium meal the calibre and transverse mucosal folds of the upper small bowel were measured. In 48 children with untreated coeliace disease there were only three (6%) with negative two-film barium meals. In 45 children with malabsorption from causes other than coeliac disease, there were four (9%) with negative two-film barium meals. It is concluded that the two-film barium meal is a reasonably reliable test for the exclusion of untreated coeliac disease in children. It is simple, cheap, safe and economical of radiological time, and it compares favourably in accuracy with other screening tests, other than jejunal biopsy.


Milk chocolate as the fatty meal in oral cholecystography. Four hundred and fifty cholecystograms were assessed regarding the effectiveness of various agents used as the fatty meal. 200 patients were given Arachis oil emulsion, 100 chocolate-Sorbitol preparation, 100 46 g of milk chocolate, and 50 26 g of milk chocolate. The films were assessed for degree of contraction, improvement in opacification, and visualisation of the biliary ducts. No statistically significant difference was found between any of the groups. It is concluded that milk chocolate is an effective palatable and cheap form of fatty meal.


The ultrasound diagnosis of hydatidiform mole. Experience with ultrasound compound 'B' scanning in 18 cases of hydatidiform mole is presented. The scan appearances are analysed with respect to the presence or absence of transonic areas, and to the uniformity of echogenicity elsewhere in the uterus. The differential diagnosis is discussed. The commonest appearance seen in a hydatidiform mole is the combination of multiple small transonic areas with uneven echogenicity in the remainder of the uterine cavity. The condition most likely to cause diagnostic confusion is early normal pregnancy with a bulky decidua, but incomplete abortion and uterine fibroid may also be confused with hydatidiform mole.


99Tcm-Sn pyrophosphate scanning in suspected acute myocardial infarction using a mobile rectilinear scanner. 99Tcm stannous pyrophosphate injected intravenously gives a positive image of freshly damaged myocardium but not of normal or scarred myocardium. It is safe, cheap and generally available. One hundred and forty patients admitted to hospital with possible myocardial infarction were scanned with a mobile rectilinear scanner of the type available in most district general hospitals. When the diagnosis of infarction was definite on clinical, electrocardiographic and enzyme criteria the anterior scan was positive in 31 out of 36 patients (86%); and when it was probable, the scan was positive in 28 out of 41 (68%) and when it was doubtful the scan was positive in 23 out of 63 (37%). The optimum time for scanning was between the second and seventh days. Pyrophosphate scanning is a very valuable investigation even though it is not an absolute discriminator of myocardial infarction. It is useful in assessing patients with atypical or doubtful symptoms of infarction where the ECG is already abnormal or where there are other causes of raised enzyme concentrations. False negative scans are not common, but a negative scan does not outweigh strong alternative evidence of infarction. Positive scans occur in some patients with unstable angina without confirmatory evidence of infarction. Positive scans due to extracardiac lesions are distinguished readily.


The lymphogram in abdominal tuberculosis. Lymphograms of 11 patients with histologically proven abdominal tuberculosis have been assessed in an attempt to define a typical pattern of appearance in retroperitoneal lymph glands. Glandular enlargement, poor glandular filling and lymphovascular obstruction were present. A gradient of abnormality with more marked adenopathy in the upper para-aortic chain extending to a lesser involvement below in the iliac chain was demonstrated in keeping with a retrograde spread of the tuberculosis process from the abdominal lymphatics cauded along the retroperitoneal chain. Lymphography may be valuable in cases where data from clinical observations and routine radiological studies is inconclusive in cases of vague abdominal disease.


Contrast nasopharyngography.

Contrast nasopharyngography. Contrast nasopharyngography was performed in 25 cases of nasopharyngeal lesions, 15 of which were carcinoma, six malignant lymphoma, and four benign lesions including neurofibroma, haemangioma, angiofibroma and tuberculosis. Nasopharyngography was also performed in 22 cases with extranasopharyngeal lesions, including nine of head and neck malignant lymphoma and 13 of tumours originating in adjacent organs. To describe the extent and site of the tumour, the nasopharyngeal walls were labelled segment 1 to 15 on axial and lateral views. The lateral skull films were negative in five of eight small malignancies involving no more than five wall segments, and also negative in six of 10 cases of unilateral involvement. Small lesions involving the unilateral fossa of Rosenmueller and/or the superolateral wall were frequently undetected. Nasopharyngography is indicated in cases where clinical suspicions of a lesion remain after a normal straight film. When malignancies were treated with radiation therapy a pre-irradiation nasopharyngogram clearly depicted the site and extent of the disease, and a post-irradiation study showed a marked shrinkage of the tumour mass and/or markedly improved raggedness of the wall of the nasopharynx. Four benign lesions showed large space-occupying lesions. In the case of tuberculosis, for example, the nasopharyngeal cavity was totally obliterated by the granulomatous tissue. In nine cases of malignant lymphoma involving the neck nodes or the palatine tonsil, the nasopharyngogram was normal.


Intrathoracic goitre: a cause of the superior vena cava syndrome. Benign lesions of the mediastinum rarely produce obstruction of the innominate vessels. Two patients with intrathoracic goitre are described who presented with the superior vena cava syndrome. Venography in each case demonstrated the extent of obstruction and degree of collateral circulation. Early recognition of the association of intrathoracic goitre and superior vena caval obstruction may lead to clinical improvement with surgical treatment.


Respiratory muscle fatigue: a cause of respiratory failure? 1. The question whether respiratory muscle fatigue ever causes respiratory failure is over 40 years old, but we still have no definitive answer to this question. Skeletal muscle fatigue occurs when the rate of energy consumption of the muscle is greater than the energy supplied, so that energy stores are utilized and eventually become depleted. 2. Five factors which are important in the development of muscle fatigue (a, the tension developed by the muscle; b, the maximum tension the muscle can develop; c, the energy stored within the muscle; d, the energy supplied to the muscle; e, the efficiency of the muscle). These can be affected in many diseases, so disposing to fatigue, thus respiratory muscle fatigue is likely to be a common occurrence. 3. Respiratory muscle fatigue can in principle easily be diagnosed at the bedside by application of a simple electromyographic technique used to detect fatigue in other skeletal muscles.


Detection of Na+ and K+ in the rat adrenal cortex with the electron microprobe. 1. In order to demonstrate whether modification of aldosterone secretion is mediated by parallel changes of K+ in the adrenal zona glomerulosa, the total (intracellular+extracellular) Na+ and K+ content of the rat adrenal cortex was determined with the electron microprobe. 2. Groups of rats were submitted to one of the following dietary regimens: standard, low Na+, high K+ or high Na+. 3. Distribution of Na+ and K+ across the zona glomerulosa and zona fasciculata was compared. Standards of known electrolyte concentration were also analysed. 4. The [Na+] was found to be greater in the zona glomerulosa than in the zona fasciculata but K+ was distributed evenly in both zones. This was independent of dietary regimen. 5. Aldosterone production, assessed by plasma aldosterone concentrations, could not be correlated with zona glomerulosa K+ content.


Vitamin D metabolism in adult rats at low and normal calcium intake and the effect of cadmium exposure. 1. Chromatography measurements indicated that adult rats converted 25-hydroxycholecalciferol into 1,25-dihydroxycholecalciferol at a lower rate than that reported earlier for young animals. In serum, less-polar metabolites were found which probably represented vitamin D esters and vitamin D3. 2. A low dietary intake of calcium resulted in an evident increase in the fraction corresponding to 1,25-dihydroxycholecalciferol in the kidneys and also in the intestinal mucosa and serum. 3. Inclusion of 0.67 mmol of cadmium/l of drinking water at a low dietary intake of calcium resulted in an increased accumulation of both cadmium and zinc in the kidneys and liver compared with values at a normal dietary calcium intake. 4. At a normal dietary calcium intake, cadmium exposure caused inhibited production of 1,25-dihydroxycholecalciferol by the kidneys and an increased accumulation of 24,25-dihydroxycholecalciferol, vitamin D3 and vitamin D esters in the serum. 5. The inhibitory effect of cadmium on the renal conversion of 25-hydroxycholecalciferol into 1,25-dihydroxycholecalciferol was almost completely counteracted by a simultaneous low dietary calcium intake. Cadmium-exposed, calcium-deficient animals also showed a maintained accumulation of 1,25-dihydroxycholecalciferol in the intestinal mucosa.


Decreased plasma renin activity and renin release in rats with phaeochromocytoma. 1. We have examined the response of renin to chronic low and high sodium chloride intake in rats with transplanted phaeochromocytoma. 2. Phaeochromocytoma suppressed the usual elevated plasma renin activity observed during sodium deprivation. 3. Studies in isolated perfused kidneys indicated that sodium-deprived phaeochromocytoma rats released substantially less renin than sodium-deprived control rats despite an almost identical renal renin content in both sets of animals. In addition, low perfusion pressure (50 mmHg) failed to stimulate renin release in kidneys from these phaeochromocytoma rats. 4. Additional experiments demonstrated that chronic sodium chloride loading suppressed plasma renin activity, renin content and renin release in both phaeochromocytoma and control rats. Both sodium-loaded phaeochromocytoma and sodium-loaded control rats were unresponsive to low perfusion pressure. 5. We conclude that noradrenaline-secreting phaeochromocytoma impairs the response of plasma renin activity in the rat by inhibiting renin release. We also conclude that chronic sodium chloride loading has a similar effect, but the mechanisms remain to be determined.


Some aspects of sodium movement across porcine aortic walls in vitro. 1. Sodium movement across the porcine aortic arch in vitro is greater from the intimal to the medial surface than in the reverse direction. 2. A short-circuit current can be measured across the aortic arch and the calculated energy is greater than the energy required to support the net outward sodium movement, suggesting the possibility of active transport of other ions. 3. Net sodium movement is not significantly altered by an adverse gradient on the outside (medial side) but is reduced by a gradient in the opposite direction. 4. Sodium retention within the tissue is increased by a gradient on the medial side. 5. The movement of [14C]inulin is greater from the medial to the intimal surface, suggesting greater porosity on the medial side. A slight rise in both total tissue fluid and extracellular fluid occurred when the sodium concentration on the medial side of the preparation was increased. This did not occur with the sodium concentration increased on the intimal side. The changes were only significant statistically for total tissue fluid. 6. The short-circuit current can be enhanced by adrenaline and reduced by a variety of beta-adrenoreceptor-blocking agents. 7. It appears that aortic tissue can actively transport sodium and it is suggested that this mechanism could play a part in blood pressure control.


Effects of analgesics and related compounds on renal metabolism in rats. 1. The metabolic effects of p-aminophenol have been compared with those of paracetamol and other analgesics in studies of rat liver and kidney in vitro. 2. p-Aminophenol injected into rats inhibited gluconeogenesis from lactate in renal cortical tubules, but not in isolated hepatocytes, and reduced kidney ATP content without affecting the ATP content of liver. Perfused kidneys from rats previously injected with p-aminophenol showed a 50% reduction of ATP content, severe inhibition of Na+ reabsorption and reduction of inulin clearance without significant inhibition of gluconeogenesis from lactate. 3. Paracetamol, p-phenetidine, phenazone and aspirin, when given intravenously to rats, had no effect on renal tubular glucose synthesis from lactate or pyruvate. Paracetamol and aspirin both slightly inhibited renal glucose synthesis from several different substrates when added directly to tubules. 4. Paracetamol (4 mmol/l) inhibited glucose synthesis from lactate and other substrates by 50% or more in isolated hepatocytes. Glucose synthesis from lactate was inhibited 30% by concentrations of paracetamol as low as 0.5 mmol/l. 5. These results indicate that p-aminophenol is a potent inhibitor of proximal tubular function, with its main site of action the inhibition of ATP synthesis and energy production, and they confirm the primary hepatotoxic effect of paracetamol.


Collagen of Dupuytren's disease.

Collagen of Dupuytren's disease. 1. In contrast to collagen from the aponeurosis of normal adult subjects, the nodules, contractures and apparently unaffected aponeurosis from patients with Dupuytren's disease contained substantial amounts of type III collagen. 2. The presence of type III collagen supports the previous proposal that the initial response to injury is the synthesis of an increased proportion of this form of collagen. The increased amounts in the apparently unaffected aponeurosis indicate the disease is not strictly focal but more systemic than is usually considered.


Excretion of salt and water by patients with sickle-cell anaemia: effect of a diuretic and solute diuresis. 1. Patients with sickle-cell anaemia were unable to increase free water reabsorption (TcH2O) in response to intravenous hypertonic sodium chloride solution. 2. Ethacrynic acid caused a brisk natriuresis in patients with sickle-cell anaemia but fractional sodium excretion was lower in these patients. 3. These findings could be explained by abnormal function of the loop of Henle.


Anaemia, iron deficiency and exercise: extended studies in human subjects. 1. Ventilation and cardiac frequency were measured during repeated treadmill exercise in three healthy subjects over 36 weeks, before, during and after iron-deficiency anaemia was produced and after iron treatment. The haemoglobin and 2,3-diphosphoglycerate concentrations and the oxygen-binding (P50) were measured. 2. There was an inverse relationship between the haemoglobin concentrations and the 2,3-diphosphoglycerate concentrations and the P50 values. 3. The mean cardiac frequencies during the fourth to tenth minutes of exercise showed a negative correlation with the haemoglobin concentrations in all three subjects, and the mean minute ventilations in two of them.


Changes in the proportions of plasma insulin, proinsulin and a higher-molecular-weight insulin during pre- and post-operative glucose-infusion tests. 1. Glucose-infusion tests were performed on patients admitted for elective upper abdominal surgery 1 day before and 1 day after operation. In addition to insulin and proinsulin, a third immunoreactive insulin species of mol. wt. 20 000--30 000 was detected in plasma from two patients. The heterogeneity of plasma immunoreactive insulin (IRI) and the need to consider the effects of all forms, including proinsulin and the high-molecular-weight species, is emphasized. 2. During preoperative glucose infusions there was an increase in the percentage of the total plasma IRI present as high-molecular-weight forms (i.e. proinsulin plus the species of mol. wt. 20 000--30 000) from 3.9% to 10.8%. On the first postoperative morning all patients showed an increase in the amounts of the heavier IRI types, which accounted for 13.9% of the total plasma IRI. 3. The changes in insulin and proinsulin are consistent with the release from the pancreas of an insulin/proinsulin mixture of constant proportions, and the longer circulating half-life of proinsulin. 4. Increases in the amounts of high-molecular-weight IRI species after surgery may have a partial role in the development of insulin resistance but are probably not a major determinant of the insulin-resistant state.


Subcellular localization of enterokinase in human duodenal mucosa. 1. Specimens of human duodenal mucosa were obtained at duodenotomy. Superficial mucosal scrapings were homogenized in isotonic sucrose solution and fractionated by differential centrifugation. The distribution of organelles among the subcellular fractions was monitored by assay of suitable marker enzymes. 2. Enterokinase was recovered predominantly in the nuclear+brush-border fraction and 80% of the total activity was found to be particulate; approximately 20% of the enzyme was present in the soluble fraction, compared with 1% of the brush-border markers sucrase and alkaline phosphatase. 3. The brush-border-containing fraction was subfractionated by treatment with hypertonic Tris followed by differential and density gradient centrifugation. Enterokinase was distributed among the subfractions in parallel with brush-border markers and was concentrated in a subfraction which was highly enriched in microvillous membranes. 4. It was concluded that enterokinase is localized primarily to the microvillous membrane of the epithelial cell brush border in man, but that in addition a proportion of the enzyme may be present in a soluble or easily released form in the duodenal mucosa.


The renin-aldosterone system in exaggerated natriuresis of essential hypertension. 1. The effect of intravenous loading with 500 ml of sodium chloride solution (50 g/l) on plasma renin concentration, plasma aldosterone concentration, urinary sodium excretion and mean blood pressure was studied in 15 young patients with mild essential hypertension and 10 healthy normotensive control subjects. 2. Plasma renin concentration and plasma aldosterone concentration were suppressed to the same degree during loading in both the hypertensive and normotensive groups. Urinary sodium excretion was significantly higher in the hypertensive patients than in the normotensive subjects. Mean blood pressure increased slightly in both groups. 3. Plasma renin concentration and plasma aldosterone concentration were significantly correlated in both groups before sodium loading. The increase in urinary sodium excretion was significantly correlated to the suppression of plasma aldosterone concentration in the hypertensive, but not in the normotensive, group. No correlation was found between changes in urinary sodium excretion and changes in plasma renin concentration or mean blood pressure. 4. The results indicate that the suppressibility of the renin-aldosterone system by hyperosmotic sodium chloride solution is normal in young patients with mild essential hypertension. It is suggested that the changes in plasma aldosterone concentration induced by sodium loading might be involved in the regulation of exaggerated natriuresis in essential hypertension.


A "superactive" charcoal for antidotal use in poisonings. Amoco Grade PX-21 powdered activated charcoal was found to adsorb nearly three times as much sodium salicylate from simulated gastric fluid than did another charcoal (Norit A), which is representative of the best of all other charcoals heretofore available. This indicates the potential superior effectiveness of the Amoco charcoal as an oral antidote in poisonings.


Tricyclic antidepressant toxicity.

Tricyclic antidepressant toxicity. Tricyclic antidepressants are dibenzazepine derivatives with adrenergic, anticholinergic, and direct cardio-depressant activity. Double-blind clinical studies show TCAD to be efficacious for two-thirds of depressed patients. Cardiac toxicity is significant, especially on diseased myocardium. Serious arrhythmias and intracardiac blocks have been reported on therapeutic doses. Tricyclic antidepressant overdose is a serious condition which is becoming progressively more common. The agents' principal toxicities are to the nervous system and the heart. The syndrome can be divided into three stages of varying severity. The vast majority of cases are in the mild Stage I. Some patients reach Stage II with major CNS effects and increasing intracardiac block. Stage III, which encompassed less than 5% of poisonings, is a potentially fatal situation with respiratory arrest, convulsions, and ventricular arrhythmias. Prevention is extremely important in poisoning therapy. Supportive measures are all that is generally needed for mild poisoning. Moderate and severe overdoses will require respiratory support, anticonvulsants, physostigmine, and beta-blockers. Cardioversion and pacing may be necessary.


Ventilation and acid-base changes in deep coma due to barbiturate or tricyclic antidepressant poisoning. Forty-two adults in deep coma due to uncomplicated overdosage with barbiturates or tricyclic antidepressants were studied to determine the effects of the drugs and the depth of coma on ventilation and acid-base balance. All the patients were breathing spontaneously. The usual acid-base disturbance was a mixed respiratory and metabolic acidosis. No differences in effects of barbiturates and tricyclic antidepressants could be demonstrated in either grade of coma studied. Patients who were completely unresponsive to painful stimuli were significantly more acidemic (arterial [H+] 51.4 nmole/liter c.f. 44.4 mole/liter) and hypoxic (PaO2 6.6 kPa c.f. 10.5 kPa) than those who showed a minimal response to pain. These findings could not be explained by differences in alveolar ventilation, and it is suggested that they are due to ventilation/perfusion imbalance.


Potentiation of tricyclic antidepressant toxicity by physostigmine in mice. Subtoxic doses of physostigmine have been found to potentiate the convulsive toxicity and lethality of amitriptyline and imipramine in CD1 and B6A mice. Neostigmine failed to potentiate the toxicity and lethality of imipramine. Physostigmine tended to protect mice against atropine-induced lethality. These data suggest the site of toxicity of this drug-drug interaction between the tricyclic antidepressants and physostigmine may be occurring in the CNS through a mechanism distinct from the anticholinergic actions of the antidepressants.


Human intoxication following inhalation exposure to synthetic jet lubricating oil. A previously healthy member of an aircraft flight crew was acutely incapacitated during flight with neurologic impairment and gastrointestinal distress. His clinical status returned to normal within 24 hr. The etiology of his symptoms was related to an inhalation exposure to aerosolized or vaporized synthetic lubricating oil arising from a jet engine of his aircraft.


Isothermal gas chromatographic method for the rapid determination of carbamazepine ("tegretol") as its TMS derivative. A rapid, simple isothermal gas chromatographic (GC) method for the quantitation of carbamazepine ("Tegretol") in serum as its trimethylsilyl derivative has been developed. A single chloroform extraction using 1.0 ml of serum, a 10-min derivatization step, and analysis on a 3% OV-1 (methyl silicone) GC column gives a linear response to a carbamazepine concentration up to 25 mg/liter. A non-drug internal standard (tetracosane) compensates for variables in extraction, injection, and instrumental changes occurring during analysis. This method was found to be free of interferences from endogenous substances in the serum, as well as from toxic concentrations of commonly used drugs. Day-to-day precision at concentration levels of 2, 5, and 10 mg/liter ranged from 2.9 to 4.4% (CV). Standard addition studies of carbamazepine added to serum resulted in a mean recovery of 95%. To ensure accurate results, all standards were prepared in serum.


Pipazethate--acute childhood poisoning.

Pipazethate--acute childhood poisoning. A previously healthy child who who had accidentally ingested an unknown quantity of 20-mg tablets of pipazethate developed severe acute poisoning with neurologic, metabolic, and cardiovascular disturbances. She recovered with symptomatic and supportive therapy.


Treatment dropouts in hindsight: a follow-up study. In a comprehensive rehabilitation center serving the mentally ill 64 dropouts and 42 successful terminees were interviewed monthly for 18 months following termination. The interview schedules elicited information about employment, heterosexual adjustment, living conditions, rent payment, social preferences, intimate friendships, and rehospitalization episodes. Analysis revealed that dropouts and successful terminees typically differed significantly on these variables for at least part of the follow-up period, but that by the end of the follow-up period there were no significant differences between the two groups on any of the variables, whether or not rehospitalization was controlled for. This hindsight examination of dropouts in comparison with successful terminees shows the concept of "dropping out" to be a time-limited concept.


The structure of attrition during appraisal. Most attrition research has focused on dropping out once the patient has arrived at the clinic. However, many potential patients, who are in need of service, do not contact clinics. Such patients are said to be in the appraisal stage of treatment. Discontinuation of appraisal, for whatever reason, can be termed "attrition." Such attrition has not received adequate attention. A conceptual model of the appraisal process is given, and a review is made of current research bearing on the conditions under which appraisals continued or discontinued by an individual. Recommendations for future research are made.


Primary prevention in community mental health centers: a survey of current activity. About half of the current activity in consultation and education services of community mental health centers can be classified as primary prevention. Using a framework that distinguishes between institutional-level interventions (caretaker training and program consultation) and individual-level interventions (dealing with developmental or situational crises) data are presented from 43 community mental health centers on (a) specific target populations that are tapped by primary-prevention activities and (b) content of the activities. Illustrative activities are described and explanations of current trends are posited. Current programming trends in primary prevention reflect the "state of the art" today and the findings in this paper have implications for the future promotion of primary prevention activity.


Social work attitudes toward birth control for teenagers. The current high level of teenage sexual activity has important consequences for the psychological and social well-being of both individuals and the community. Because social workers often have professional contact with teenagers who are in need of contraceptive services, a nationwide survey was conducted to ascertain the attitudes of social work faculty and students toward birth control for teenagers. Both students and faculty were found to have positive attitudes. They are willing to provide service in this area within the bounds suggested by a realistic assessment of their preparation for this field of activity.


Histological aspects of skin reactions to propylene glycol. In view of the increased use of dermatological preparations containing a high concentration of propylene glycol (PG) for use under occlusive dressings, patch tests were performed with pure PG in a group of 98 out-patients at a skin clinic. No indication of a possible allergic contact dermatitis to PG could be found in the history of any of these patients. In 11 of them, the patch test reactions after a 48-h application were positive. In eight cases the reaction was scored as one plus, in two cases as two plus, and in the remaining case a three plus reaction was observed. In view of the negative history of all patients, the observed reactions were considered to be of a primary irritant nature. Histological examination of the positive patch tests revealed some definite quantitative differences between one and two plus reactions on the one hand and a three plus reaction on the other. The findings suggest that the application of high concentrations of PG under occlusive dressings may give rise to skin reactions of a primary irritant character which may closely simulate an allergic reaction.


Immediate reactions to patch tests with balsam of Peru. Closed patch tests with balsam of Peru gave rise to nine immediate reactions among 121 patients with different dermatoses and to 10 reactions among 57 patients with chronic urticaria. Among compounds of balsam of Peru, cinnamic aldehyde, cinnamic acid benzoic acid and benzaldehyde also gave the same reactions. The reactions could not passively be transferred with serum from patients. They were abolished by antihistamine given before testing, and by pretreatment with compound 48/80. Balsam of Peru and cinnamic aldehyde did not provoke new symptoms when given orally to patients.


A study of oil of bergamot and its importance as a phototoxic agent. II. Factors which affect the phototoxic reaction induced by bergamot oil and psoralen derivatives. Using a standardized open photopatch test technique, the phototoxic reactions produced by bergamot oil bergapten (5-methoxypsoralen) the active component of the oil, and xanthotoxin (8-methoxypsoralen) were studied. The reaction was affected by a range of factors such as the vehicle (PMF or ethanol), the concentration of ethanol in the vehicle, the skin site, the interval between application of the psoralen and irradiation, the hydration of the skin, and the degree of natural or sun-induced pigmentation. Repeated photopatch testing at the same skin site produced an increase in sensitivity. Eye colour, natural susceptibility to suntanning, age, and sex, had no effect on the phototoxic response to psoralens.


Sensitivity to isopropyl alcohol.

Sensitivity to isopropyl alcohol. Positive patch test reactions to isopropyl alcohol in connection with proved allergy to ethyl alcohol have already been published. A case of allergy to isopropyl alcohol with positive reactions to isopropanol (unpurified test material) and negative reactions to ethanol and methanol has also been reported. We report a case of a occupationally acquired sensitivity to isopropyl alcohol in which, on testing with gas chromatographically purified material, positive patch test reactions were found to 1-propanol, 1-butanol, 2-propanol, 2-butanol and methanal (formaldehyde) but not to the primary alcohols methanol, ethanol and amyl alcohol; not to the aldehydes acetal (acetaldehyde) and butanal; nor to the ketones acetone, butanon and isobutyl ketone, nor to methanoic (formic)acid. A tentative explanation for this peculiar pattern of reactions is given.


Pigmented cosmetic dermatitis and coal tar dyes. Patch tests and photopatch tests with various cosmetics, coal tar dyes, perfumes, lanolin preparations and parabens-mix were performed in 53 patients with pigmented cosmetic dermatitis similar in clinical appearance to Riehl's melanosis. The results showed that coal tar dyes, particularly brilliant lake red R, were closely related to the cause of the disease. In patch testing and photopatch testing with coal tar dyes, the incidence of positive responses to the brilliant lake red R was found to be significantly higher than that to the other coal tar colors (22/38 = 57.9%). The relevance of ultraviolet light to the disease was found to be much less than the ratio expected (14/47 = 29.8%). A high incidence of positive responses to fragrances was also found, but it is considered to play a secondary role in the etiology of the disease.


Sodium lauryl sulfate irritant patch tests: degree of inflammation at various times. Irritant reactions were induced on the forearms of 10 normal subjects with 10% aqueous sodium lauryl sulfate under patch test occlusion for 24 h. Test sites were observed at 24, 26, 28, 30, 48, 72 and 96 h and the degree of inflammation recorded. Inflammation was most prominent at 28 h and decreased in intensity over the time course of the study. Inflammation at 48 and 72 h was similar to when patches were removed. This suggests that inflammatory responses in skin for at least certain irritants like sodium lauryl sulfate do slowly decrease in intensity after 48 h. However, the inflammatory response may initially accelerate after patch test removal and remain intense for at least 48 h. Fading of irritant reactions by 48 or 72 h may not reliably distinguish irritant from allergic patch test reactions. This does not refute the usefulness of a delayed (96 h) reading since inflammation from sodium lauryl sulfate had decreased significantly by this time.


The measurement of the work of breathing for the clinical assessment of ventilator dependence. The work of breathing was measured in 10 normal subjects and in 28 critically ill patients with acute complications of obstructive pulmonary disease treated with assisted ventilation. The measurement of the work of breathing was found to be a useful objective variable for determining the capability for independent ventilation. Dependence on mechanical ventilation was observed when the respiratory work was greater than or equal to 1.7 kg-m/min. Patients were ordinarily capable of spontaneous ventilation when the respiratory work was less than or equal to 1.0 kg-m/min. Discontinuation of assisted ventilation was likely to be successful in those patients whose respiratory work was less than or equal to 1.5 kg-m/min if the patient was able to increase and maintain his work capability by a factor of two when breathing against an inspiratory resistance of 5 cm H2O for 10 min. Failure to increase the respiratory work when breathing against an inspiratory resistance indicated limitations in respiratory mechanics and was associated with the need for prolonged assisted ventilation. The measurement of the work of breathing against an inspiratory resistance of 5 cm H2O was useful in the identification and quantification of ventilatory reserve in patients with obstructive pulmonary disease.


How noisy is intensive care?

How noisy is intensive care? Expense, noise, and bright lighting have been acknowledged disadvantages of ICU's since their establishment. Data are available regarding the first, but not the latter two disadvantages. Background sound levels were measured in four units and found to be comparable to the hospital cafeteria at noon, and only somewhat less noisy than the boiler room. Sound levels generated by numerous components of the environment were measured and related to the total noise level. Noise levels generated by seven different nebulizers, each used at three different settings, were found to show noteworthy differences. High noise levels have been shown to have adverse physiological and psychological effects on patients and on the errorproneness of intensive care personnel. If noise generation is a consideration in selection of equipment, industry can respond appropriately. Further studies can lead to measures that will reduce the noise level in ICU's.


The effect of pentoxifylline on erythrocyte deformability and on phosphatide fatty acid distribution in the erythrocyte membrane. Ten maturity-onset diabetics with chronic vascular disease were treated with 400 mg pentoxifylline 3-times daily for 14 days. Erythrocyte deformability (using a filtration technique for whole blood) and phosphatide fatty acid distribution in the erythrocyte membrane were measured before and after the treatment period. Statistical analysis of the data showed that the erythrocyte filtration rate had increased significantly by the end of treatment (2alpha = 0.02), and that there were only slight changes in erythrocyte membrane phosphatide fatty acid levels. The drug was well tolerated, and there were no adverse laboratory findings in the parameters measured. On the basis of results described by other investigators, theimprovement in erythrocyte deformability was attributed to an increase in erythrocyte ATP levels. The authors discuss the importance of red cell fluidity for capillary perfusion.


A new mechanical method to influence pulmonary perfusion in critically ill patients. A new device, the Roto-Rest bed, has been used in critically ill patients to effect lateral to lateral position changes and continuous rotation to influence distribution of pulmonary blood flow. Selection of extreme lateral position can be made particularly in cases of respiratory failure with primarily unilateral involvement. Dependent positioning of the uninvolved lung to match ventilation and perfusion can be accomplished simply. Rapid resolution of a large pulmonary contusion serves to illustrate the clinical use of the apparatus.


Prazosin combined with thiazide diuretic and beta-blocker in the treatment of hypertension. In a study of 10 patients suffering from hypertension the results showed that combination treatment with prazosin, cyclopenthiazide and a beta-blocker produced a significant fall in blood pressure. Side-effects such as palpitations, headache, syncope and drowsiness which may occur with prazosin alone were obviated by combining prazosin with a beta-blocker.


Fluspirilene in the treatment of non-hospitalized schizophrenic patients. A study was carried out to assess the efficacy of fluspirilene, a long-acting psychotropic agent, in the treatment of 29 non-hospitalized schizophrenic patients. Patients received an initial weekly injection of 6 mg to 10 mg fluspirlene, depending on the severity of the illness, and this was increased by 2 mg weekly as necessary to achieve control without side-effects. The mean weekly dose after stabilization was 9.2 +/- 3.4 mg (range 6 mg to 20 mg). Global assessment of patients' response to treatment showed a significant improvement in schizophrenic symptoms within 4 weeks in 20 of the 29 patients, and in 24 of 29 by the end of the 12-week trial period. Four patients were unable to be controlled in the community and were admitted to hospital. Side-effects were minimal and led to withdrawal of treatment in only 1 patient. It is suggested that fluspirilene is a useful drug in the treatment of schizophrenics without having to admit them to hospital initially.


Acute hallucinosis due to clonidine.

Acute hallucinosis due to clonidine. A case is reported of a 54-year old man who developed acute hallucinosis while being treated for hypertension with clonidine. The history revealed a similar previous episode which also cleared on discontinuation of the drug.


Clinical results of photochemotherapy. The Cleveland Clinic experience. PUVA therapy has proved to be beneficial for dermatologic conditions such as psoriasis, vitiligo, and mycosis fungoides. Attempts have been made to treat other diseases with the modality; five patients with pityriasis rubra pilaris were treated, with only a partial response noted in one. A poor to fair response was seen in treating a small group of patients with cystic acne, atopic dermatitis, and neurodermatitis. As might be expected, no response was seen in one patient with Darier's disease. At present, photochemotherapy must be viewed with cautious optimism. Strict adherence to a rational treatment approach and close longterm follow-up observations are essential for determining the safety of this modality.


Essentials for PUVA therapy. Guidelines for photochemotherapy. PUVA therapy is a promising new entity for treatment of a number of dermatologic diseases including psoriasis, mycosis fungoides, and vitiligo. A safe and rational approach to the management of a phototherapy center has been presented, and is intended to serve as a personal guideline for those treating patients with this modality.


Psoriasis with oral manifestations.

Psoriasis with oral manifestations. A forty-seven year old woman had skin and oral lesions of three year's duration. The skin lesions were clinically and microscopically diagnosed as psoriasis. Oral examination revealed extensive involvement of the entire mucosa with white, elevated, circinate lesions. Biopsies of oral mucosa were interpreted as histologically similar to the characteristic dermal findings in psoriasis. Anesthetic mouth rinses afforded symptomatic relief; however, although there was definite improvement, the oral lesions have persisted.


Porokeratosis plantaris discreta.

Porokeratosis plantaris discreta. Sire the basis for this study. All cases were clinically diagnosed as porokeratosis plantaris discreta (PPD). Biopsies were done in fifteen cases. Of these, eleven were confirmed as PPD and four had histopathologic features of a wart. Porokeratosis plantaris dicreta is a localized plantar hyperkeratosis that is resistant to therapy. It is often mistaken for a wart. PPD should be considered in the differential diagnosis of keratotic lesions on the sole.


The health status of foster children.

The health status of foster children. A study of the health care and needs of foster children in the New York City area indicated a prevalence of serious physical, mental and developmental problems. The level of pathology was roughly comparable to that of other disadvantaged child populations.


Case reopening: an emerging issue in child welfare services. A retrospective longitudinal study of the frequency and correlates of case reopening in a child welfare population revealed that one-third of all closed cases were reopened. Predictors of reopening were the child's age, ethnicity and prior agency experience.


Observations on going coed in a correctional center. When a school for delinquent girls converts to a coeducational program it faces major problems, including staff attitudes, residents' reactions, and the control of destructiveness, sexual acting out, and drugs.


Complications of ventriculo-peritoneal shunting and a critical comparison of the three-piece and one-piece systems. This is a report of our experience with ventriculo-peritoneal shunting, the treatment of congenital and secondary hydrocephalus. It includes a detailed listing of all complications and an analysis of the number of complications per patient and per procedure in patients in whom either a three-piece or a one-piece shunt system has been inserted. A total of 161 patients were in the one-piece series and 196 patients in the three-piece series, with the follow-up being a minimum of 6 months. There were 598 procedures in 196 patients in the three-piece series and 302 procedures in 161 patients in the one-piece series, so that the average number of operations per child in the three-piece series was 3.1 and only 1.9 in the one-iece series. There were 106 instances of ventriculitis in the three-piece series only 22 in the one-piece series, and 47 non-ventriculitis related complications in the three-piece series, but only 17 in the one-piece series. Data are presented descriptively with listing of specific complications and as computer analysis statistical printouts for categories (disconnections, infections, obstructions) comparing the three-piece and one-piece systems.


Displacement of the superior sagittal sinus associated with a brain tumor. A 13-year-old girl with an 11 1/2-year history of seizures, was found to have a brain tumor and contralateral displacement of the superior sagittal sinus and falx. The rarity and possible mechanisms of sagittal sinus displacement are discussed.


[Influence of exogenous collagen on the metabolism of skin wounds in rats]. Skin wounds of rats were treated by 14C-labeled collagen from guinea pig skin. The main portion of the applied collagen persisted in the wound area. In the neutral salt soluble collagen maximal specific activity was measured on day 4 after treatment, in the citric acid soluble and in the insoluble collagen at later times. On day 4 after treatment 3.42% of the applied label was found in the neutral salt soluble, 1.43% in the citric acid soluble and 1.40% in the insoluble collagen. The findings suggest that the stimulation of wound healing which is reported by various authors is caused by the incorporation of the applied collagen into the regenerating connective tissue.


[Radiation protection measurements at the intensive care unit and in the operating room]. For chest X-ray in the ward and for intraoperative cholangiography the registered doses were low. A limitation of the exposures or the operations was not necessary. For osteosynthesis operations the doses for the patient and the staff could be kept low by preparing the operation adequately, by using modern image-intensifer units with grid and automatic regulation in fluoroscopy, and with discipline in using fluoroscopy. During one week a surgeon could do eight osteosynthesis operations without reaching legally imposed dose limit. The control area could be restricted to a space around the patient with a radius of two meters.


[The functionally defective Roux Y-loop in biliodigestive anastomoses]. In comparison to common radiologic methods hepato-biliary sequential scintigraphy proves superior in the investigation of the choledocho-(hepatico-)jejunostomy Roux-en-Y. The functional behavior of the jejunal-(Roux-en-Y-) loop is demonstrated. After biliary-intestinal anastomoses, 15 healthy patients showed normal dynamic studies with unimpeded bile passage. Hypotonic loops with intrahepatic bile stasis responsible for cholangitis were seen in 2 patients. A strangulation phenomenon on the level of the mesocolon hiatus responsible for upper abdominal pain is demonstrated in one case.


[Selection of procedure in the management of recurrent juvenile and aneurismatic bone cysts]. Aneurysmal and juvenile bone cysts are characterized by frequent recurrence and pathological fractures caused by such bone cysts also recur frequently. Curettage of the cyst and spongiosaplasty is often unsuccessful. According to our experience, excochleation must be followed by drilling the cyst wall and fraising off the compact substance. Densely packed homologous spongiosa must then be implanted. In case of recurrence or if the cyst increases in size, radical en-bloc resection is indicated and the defect must be bridged by osteoplastic and osteosynthetic methods. We have treated four difficult cases successfully with this procedure. In one case, resection with limb shortening lead to full recovery.