Scanning electron microscopy of the bile ductule. Scanning electron microscopy of a liver biopsy specimen from a patient 6 months after the onset of acute hepatitis revealed a normal appearing bile ductule. The bile ductule was 13 micron in outer diameter and 1.5-2.7 micron in inner diameter. The ductular lumen was surrounded by two ductular cells and ampullary dilated at the canalicular side. In the lumen, intracytoplasmic diverticles were observed with an orifice diameter of 0.9 micron. About 15 microvilli 0.4-0.6 micron in length and 0.1 micron in thickness were observed on 1 micron2 of luminal surface. The number of microvilli was calculated to be approximately 1,500 per ductular cell. A single cilium 0.15 micron in diameter at the base and 0.10 micron at the trunk, and 7-15 micron in length was found on each ductular cell. The cilium arose from a recess at the canalicular side of the ductular cell, and the free-end was on the bile-duct side. The cilia seemed to play an important role in bile flow to the duct. Sometimes between the ductular cells at the edge of the basal portion a cell was intercalated with thin processes. Such thin processes were not observed on ductular cells.


Pathogenesis and treatment of pancreatitis due to essential fatty acid deficiency. Pathogenesis of pancreatitis was studied in experimental animals and essential fatty acid deficiency was condemned as an etiological factor, since it caused pathological changes in permeability of cell membrane of the pancreatic acinar cells. Favorable effects of intravenous fat emulsion was clearly demonstrated in treatment for acute and chronic pancreatitis.


A case of carcinoma of the common bile duct, diagnosed at the non-icteric stage of the disease. It is rather seldom to detect a cancer of the common bile duct at the non-icteric stage of the disease. This report presents a non-icteric case of carcinoma of the choledochus. A 70-year-old woman complained of r-hypochondralgia with occasional fever. Laboratory examination revealed an increased serum alkaline phosphatase activity without any elevation of serum bilirubin content. The oral cholecystography failed to visualize the gallbladder. By endoscopic retrograde cholangiopancreatography (ERCP), a bilateral filling defect was demonstrated at the common bile duct. Pancreatoduodenectomy was performed and the resected specimen showed a 1 X 2 cm tumor (adenocarcinoma) at the choledochus. She is now in good health over 13 months after operation.


[Phenomenologic-mathematical modeling of the human-body-length growth through the analysis of growth periods and their quantitative-analytical registration]. The body height growth (of masculine beings) was modelled in a phenomenologic-mathematical manner by partitioning the time course of measured growth curve in parts every of which corresponds to a separated growth period. This partitioning was reached in a natural way so that a superposition of the single spurts yields the whole measured course. Every growth batch will be described in its time course by one term of inverse tangent function. The biological meaning and an explanation of the succession of the growth spurt as an effect of control circuits need further exploratory work. For detailed statements on acceleration phenomena concerning the body height growth this analysis gives possibilities for comparing the single growth spurts of the mean growth process of two populations in question. For measured values given by BROCK (1954) and SALZLER (1967) there are five growth periods in the time intervall reaching from time of conception until the end of the first year. Comparing the mathematical functions of the corresponding growth spurts for these two groups one can conclude that the second spurt (fetal spurt) is responsible for an increase of birth body height and the fourth for an increase of body height in the suckling age of the latter group against the former one.


Coupling thermodynamics applied in chemical morphogenesis; influence of environmentally organized space-time structures upon nonequilibrium entropy functions of multivariate biosystems. In this paper is proposed the so-called coupling thermodynamics which deals with coupled variables or elementary units which are influenced by input-output relations. In contrast to the usual definition of nonequilibrium entropy, external influences are considered directly in the entropy function dependent on space and time. The employment in morphology leads to a model of organized growth.


[Architecture of the human skullcap in the region of the pars bregmatica suturae sagittalis. I. Age dependence]. For scientific investigations of human skeletal remains--e.g. material from cremations--there are often only rather small bone fragments available. The analysis of their inner structure presents itself as one of the few possibilities of finding evidence to characterize the former individual. The article presented here demonstrates structure findings (calvarial thickness; relation between tabula externa, tabula interna, and diploe [in terms of the percentage of the whole section examined], porosity of the diploe [including the mean width of its cavities]; degree of obliteration of the sagittal suture) of a strictly defined skeletal segment in special regard to the expected variability. With the help of the results, change tendencies--not "age changes"--of the investigated components will be discussed.


[Nasal cavity and paranasal sinuses of the roe-deer (Capreolus capreolus) (corrision-anatomical and x-ray studies)]. By means of about fifty skulls of dominating female animals of all age groups the formation and topgraphy of the Cavum nasi and its Sinus paranasales at the roe-deer are investigated and described by pouring out the Sinus paranasales about their physiological entrances with Technovit 7143. Amongst numerous findings the main results are in the following: 1. the total absence of a Sinus frontalis, 2. the characteristic formation of the Sinus ethmoidales. The results are compared with the well-known findings at the sheep and goat and the differences are put out. Furthermore a critical discussion with the hitherto existing opinions about the pneumatisation of the skulls at the roe-deer is given.


[Form, size and variations of the plexus chorioideus ventriculi IV]. The form, size and variations of the Plexus chorioideus ventr. IV were investigated on 55 brain stem specimens. Because up until now there has been no definitive standard nomenclature, the plexus has been divided into a medial part (Pars medialis)--with its Processus fastigii, Processus inferior and Processus paramedianus--and into a lateral part (Pars lateralis). The plexus parts which stickout of the apertures are accordingly termed Partes aperturae lateralis et mediana. The greatest transverse expansion (= span of the plexus) varies between 27 and 52 mm. The greatest longitudinal values measured along the arc are between 10 and 40 mm. The variability of the Processus fastigii--if present--varies between 3 and 9 mm in length and has been schematically presented along with the position of the Processus paramedianus and the length of the Processus inferior. The size of the plexus-free middle area, its form and form-varitions, likewise has been studied and has been presented in schematic drawings and evidenced with photographs, along with those of the Apertura lateralis and the diverse lengths of the Pars aperturae mediana.


[Classification of the abnormality concept]. This paper deals with congenital malformations in man and presents a classificatory system for them. It first distinguishes abnormalities from normal variation and then further separates between primary and secondary structural disorders. Secondary disorders are those which are due to disturbances in primary normal tissues. Every maldevelopment which originates in prenatal life, is a congenital malformation. The level at which the malformation occurs must be considered, i. e. whether it is at the organism level, organ level, tissue, cell or subcellular level. A standardized system is absolutely necessary if the incidence of malformations is to be compared throughout the world.


Adrenal dehydrogenases in alloxan diabetic rats following continuous exposure to light. The enzymes delta5-3beta-hydroxysteroid dehydrogenase delta5-3beta-HSD) and glucose-6-phosphate dehydrogenase (G-6-PDH) were demonstrated histochemically in the adrenal cortex of female rat. The activities of these enzymes were increased significantly in the alloxan-treated rats kept in LD (light: darkness) cycles of 10:14 h. Continuous light exposure to diabetic animals appeared to decrease delta5-3beta-HSD and g-6-PDH in comparison to the diabetic rats kept in 10 h illumination. The evidence indicates that suppression of adrenal steroidogenesis in diabetic rats after exposure to continuous light is due to the alteration of pentose phosphate pathway.


[Demonstration of the surface values of spheroid cell nuclei, determined in natural size order, in relation to the large and small diameters of the nuclear incision surface, as a measurement value; a further contribution to the statistics of nuclear variation]. The paper explains how the formulas for calculating the surface area of the prolate spheroid, which a nucleus resembles, can be changed by suitable substitutions into formulas based on measured diameters l and k [mm] of the nucleus approach side surface, magnified 3.000 times, and on a mixed cyclometric function dependent on the axial ratio. Their values established for distinct axial ratios are compiled in a table. The values of the mixed cyclometric function are to be calculated for any other axial ratio according to a formula based on linear interpolation. The nucleus surface Omu is obtained in the natural order of magnitude [micron2]. In case of constant axial ratio, the surface area values form a second-order arithmetic progression, and a recursion formula has been developed to check the values of its terms. In case of nuclei of spherical shape or constant small diameter k, the surface area formulas may be simplified. Numeral examples serve for explanation. For all measured-value combinations involved, a second part, which is being prepared, will contain a complete table of function values, which is referred to in the Appendix and from which the values of the natural surface areas of spheroid nuclei can be gathered.


[Architecture of the human skull cap in the region of the pars bregmatica suturae sagittalis. II. Sex characteristics]. There has previously been no treatise on the inner architecture of the human cranial vault other than those dealing with common "age changes". Such a treatise ought to refer to a particular segment of the vault demonstrate the peculiar structure according to age in both sexes, and also take into consideration their normal variability as presupposition for using the results in estimating the age of prehistoric skeletal material. With the help of thin sections across the sagittal suture and the adjoining cranial vault 10 mm behind the bregma findings about the specific structure as to age and sex and their expected variability are demonstrated by more than 200 cases taken from the recent population. According to the results in hand there exists a contradiction to the opinions hitherto existing about a distinct age dependence in the bone structure and distinct sex differences in the findings of the structures of the Ist order. Though data about changes in the anatomical construction of the human cranial vault during the ontogenesis are to be correctly obtained only with the help of longitudinal investigation, the crosssectional investigation produced only differences between the age classes. Real differences were not to be found, but there are to be derived possible tendencies of development for the calvarial thickness, for the relation between the compact bone (tabula externa, tabula interna) and the porous bone (diploë), of the porosity in the diploë and the obliteration of the suture in the course of increasing age. No significant sex differences were found but there are sex peculiarities or at least inclinations to it. The use of the findings taken from the cross-sectional aspect of the cranial vault in order to estimate the age at death and the sex as well as indications of possible individual peculiarities, at present ead to a sufficiently reliable diagnosis only within a polysymptomatical practice.


[Possibilities and limitations in the use of the biomathematic procedure in variability studies on man]. In an anthropomorphical variability analysis the quantitative description of deterministric changes of (morphological) growth characteristics plays an important role. Working out this component of general variability and its discrimination from the random component in the measureed values underlying the quantitative analysis can be performed by biomathematical procedures. Three groups of such procedures are presented here in a survey manner. They may be employed at different levels of data processing and for quantitative description resp. mathematical modelling of the biological process in question. There are: Empirical regression, so-called internal regression, and nonlinear regression or approximation. The advantages fo employment biomathematical procedures for evaluating and interpretation of measured values of dynamical processes are sketched for the body height growth of human beings as example. But there are also mentioned limitations of application mathematical methods and procedures in the biological area.


[Tissue mechanical behavior of tendinous fibers under statistical and dynamic requirements]. With a device for dynamical processes tension tests were performed on bundles of collagen fibres of human and bovin origin. Part of the studies were performed under statical condition with an universal materials testing machine, equipped with a closed loop feed back control system. If the force is to be kept constant subsequently to a strain process on a collagen fiber bundle (isotonic condition), the fiber length must increase (creep phenomenon, retardation). The force decreases under constant length after a preceding strain process (relaxation). In analogy to the statical relaxation, statical isorheological line, and statical force recovery curve the dynamical (cyclic) relaxation, dynamical (cyclic) isorheological curve, and dynamical (cyclic) force recovery curve are described. The mechanical-rheological properties collagen fiber bundles are discussed in relation to functional anatomy.


[Reverberation of the hindlimb rudimentation on its innervation in squamate reptiles]. When the dimensional reduction of the hind limb begins, a first caudal displacement of the lombar part of the lombo-sacral plexus - which involves the loss of the first root of the sacral part -- appears with a threshold in the increase in the number of presacral vertebrae. This a first indication of the serpentiform tendancy. Others thresholds can conduct to produce the disappearance of the sacral vertebrae and sacral root. The qualitative reduction only concerns the terminal branches of the plexus and does not seem to be associated with the vertebral elongation. If a caudo-proximal reduction of the brachial plexus occurs early in the lepidosaurian line and exists in all the Squamata, even in the Iguana which have well developed limbs, it is not the same for the reduction of the lombo-sacral plexus which does not appear in these Iguana. At last, if the reduction modalities of the both plexus are often differents, their supposed displacements facilitate the extension of the intermediate vertebral region.


Ultrastructural and cytochemical observation of calcium ion localization in the black-beetle pleural muscles. The authors examined the infrastructure and distribution of calcium ions in the plexural muscles of a black-beetle (Blatta orientalis L.) after being fixed in a solution of osmiumtetroxide buffered with a cacodylate buffer (pH = 7.4) and according to the method of Carasso-Favard (1966). The infrastructure of these muscles differs from the muscles of other insects, first of all, in the amount and distribution of the sarcoplasmic net (SR) and mitochondria and also in the amount and topography of the location of lead precipitations which mark the calcium ions. The authors ascertained an intensive and permanent positive reaction to the presence of calcium in the mitochondria and sarcotubular systems of the sarcoplasmic reticulum, and in the intrafibrillar spaces and in the Z and M lines of the sarcomeres calcium concentrations are not detectable. The authors checked the results by using the method of Carasso-Favard (1966).


[Topographic anatomical data on the a.testicularis, a.ductus deferentis and a.cremasterica in ram]. 130 Ram testes have been used in the study, and the following methods were applied to fill and study the testical arteries: röntgenography, stereoröntgenography, corosive method, Indian ink and gel injections. Variabilities occur as to the site where the a.testicularis arises in rams. Individual differences can also be observed in the arrangement of the epididymal arteries, in most cases, however, they arise from the first loops of the convolution. Both epididymal arteries are considerably thinner than the testicular artery, forming 2 independent vessel convolutions, located at both sides of the convolution of the a.testicularis, and not interfering with the loops of the latter. A.accessoria testis has been found in one ram only. 2 to 3 large waved loops can be observed in the pars marginalis and the a.testicularis of the ram. Bifurcation mostly occurs in the second third of the margo epididymidis. Individual variations have been found at further ramification of the rr.testiculares. The shape of the lobulus testis is indicated by the centripetal branch with its centrifugal twigs. In rams the a.ductus deferentis forms anastomoses both with the branches running from the a.epididymidis caudalis and the a.cremasterica.


Transformation with specific fragments of adenovirus DNAs. II. Analysis of the viral DNA sequences present in cells transformed with a 7% fragment of adenovirus 5 DNA. Five clones of rat kidney cells transformed by a small restriction endonuclease fragment of adenovirus 5 (Ad5) DNA (fragment HsuI G, which represents the left terminal 7% of the adenovirus genome) were analyzed with respect to the viral DNA sequences present in the cellular DNAs. In these analyses, the kinetics of renaturation of 32P-labeled specific fragments of Ad5 DNA was measured in the presence of a large amount of DNA extracted either from each of the transformed cell lines or from untransformed cells. The fragments were produced by digestion of 32P-labeled adenovirus 5 DNA with endo R.HsuI, or by digestion of 32P-labeled fragment HsuI G of adeno 5 DNA with endo R.HpaI. All five transformed lines were found to contain DNA sequences homologous to 75--80% of Ad5 fragment HsuI G only. Clones II and V contained approximately 48 copies per quantity of diploid cell DNA, clone VI about 35 copies, clone IV 22 copies and clone III 5--10 copies. These results indicate that a viral DNA segment as small as 5.5% of the Ad5 genome, contains sufficient information for the maintenance of transformation.


Purification and cloning of a mouse ribosomal gene fragment in coliphage lambda. We have found and characterized a recombinant between the EK2 vector lambdagtWES.lambdaC and a portion of the mouse ribosomal genes. A 6.6 kb endoR.Eco RI fragment was purified from total mouse DNA using RPC-5 ion exchange chromatography and then cloned and detected twice among 183 hybrid phage screened. In situ hybridization of restriction fragments of the hybrid phage DNA revealed that the inserted fragment contained both 18S and 25S RNA sequences. Electron microscopic analysis further suggested that most, if not all, of the 28S RNA sequence was present in the insert. The orientation of the 28S sequences in the hybrid phage was such that the "sense" of the inserted fragment should be under the control of the leftward promoter of lambda.


The Moberg deltoid-triceps replacement and key-pinch operations in quadriplegia: preliminary experiences. The use of the tendons of the lateral four extensors of the toes in order to transfer the pull of the posterior deltoid to extend the elbow is successful in the OCu:2 quadriplegic patient. The Moberg operation for key pinch in its various modifications also improves the function of these patients and is well received by them. The necessity for prolonged protecton (three months) and for simplicity in surgical procedures in these patients is illustrated in seven patients.


The use of the key grip procedure for improving hand function in quadriplegia. Reconstruction of the quadriplegic hand can give marked functional improvement. In 1975 the key grip procedure was introduced on the Spinal Injuries Unit at Rancho Los Amigos Hospital. Twenty of the first twenty-four cases operated on have obtained a useful improvement, and the reasons for the four failures are readily seen. In correctly cases the key grip procedure is of benefit to the patient and complications are relatively minor.


A review of 100 flexor tendon reconstructions with prosthesis. A series of one hundred cases where silicone rods were used to prepare a bed for flexor tendon grafting is examined, the main indication for this technique being circumstances where one stage tendon grafting was likely to have a poor result. The main complications noted were a synovitis around the silastic rods, infection, and loss of the distal attachment of the silastic rod. The overall results were satisfactory.


Functional disability in the rheumatoid hand. The investigation of sixty-one rheumatoid patients relates their hand function to measured hand deformity. Certain deformities are related to a reduction in function; others are not. The dominant hand, used more frequently, deteriorates more quickly than the non-dominant. The benefit on hand function of synovectomy is limited in duration and should be accompanied by some procedure to defer or correct deformity. Study of the metacarphophalangeal joints by radiography and at operation shows that degeneration starts where the metacarpal head first loses articulation with the base of the phalanx, and spreads out from there across the metacarpal head as deformity increases.


Use of intramedullary polypropylene peg for joint stabilization in leprosy. Joint arthrodesis is indicated when motion in a joint cannot be restored, and that joint requires stabilization in an optimal functional position. The Harrision Intramedullary peg has been used to advantage for this purpose in hand reconstruction in leprosy in a renal developing area. It is a method to be considered for selected cases requiring joint stabilization to improve total hand function.


Dynamic profundus splint for flexor profundus repair. Flexor profundus is a mass action muscle so that when we fully extend one finger including full extension of the distal joint the entire muscle is pulled distally. By fully flexing the injured or operated finger at the metacarpophalangeal joint and fully extending the adjacent fingers, flexor digitorum profundus of the operated finger is made so redundant as to abolish all tension at the suture line. The position of the operated finger: metacarpophalangeal joint flexion with interphalangeal joint extension is ideal for the preservation of joint mobility and therefore ideal for the restoration of movement when the repaired flexor tendon is mobilized. It is permissible to splint a healthy finger in full extension for three weeks.


Acquired club hand--a case report.

Acquired club hand--a case report. An exceptional case of acquired radial club hand is recorded. Although clinically similar to the congenital club hand, it has developed in a normal hand, as a result of osteomyelitis.


Congenital absence of the flexor pollicis longus--a case report. Congenital absence of the flexor pollicis longus, associated with hypoplasia of the thumb, is an unusual anomaly. A case of congenital absence of the flexor pollicis longus without hypoplasia or aplasia of the thumb and thenar muscles, which is described, is very rare. Surgical treatment for the transfer of the ring finger flexor superficialis tendon to provide the thumb interphalangeal joint with flexion resulted in a significant improvement in pinch.


Congenital metacarpal malformation.

Congenital metacarpal malformation. The findings in two brothers are described in whom there are similar isolated defects of development of their fifth metacarpal bones with normal fingers. There is no evidence of further skeletal, or biochemical abnormality. A mutational genetic basis is postulated.


Dermatitis artefacta.

Dermatitis artefacta. An unusual case of dermatitis artefacta is presented. The patient lost the whole of the index finger of his dominant hand before the diagnosis was established. The motive was financial gain. The literature on self-inflicted disease is reviewed.


Complications of radial artery catheterization. Sixty patients, representing a ten per cent incidence of complications, developed ischaemic or necrotic changes in the involved hand following radial artery cannulation. The loss of digits or hands could have been avoided by adequate evaluation of the vascular status of the hand both before and after cannulation.


Cystic tuberculosis of a metacarpal. An unusual presentation of primary lung disease. A white woman of thirty-two years presented with tuberculous osteitis of the third metacarpal head, secondary to previously undetected active pulmonary disease. The problems of diagnosis are illustrated by review of her history, and the literature is discussed.


Osteoid osteoma of the terminal phalanges. Four cases of osteoid osteoma of the terminal phalanx--a very rare location--are presented. The clinical picture of cell cases is essentially the same, gradual swelling of the terminal phalanx with enlargement of the nail and pain, particularly at night and relievable by aspirin. The treatment was operative and of double value. 1. The osteoid osteoma is removed; 2. Cosmetic result is obtained by reduction of the size of the terminal phalanx.


Knuckle pads in Dupuytren's disease.

Knuckle pads in Dupuytren's disease. Knuckle pads are not exclusively found in persons with Dupuytren's disease, but they occur four times more often in these patients than in the general population (in Norway). Occurrence of knuckle pads in persons with Duputyren's disease does not seem to imply a higher predisposition or a more aggressive disease.


Synovium as a nutritional medium in tendon grafting. The mechanism of tendon healing and the role played by the synovial sheath are still obscure and controversial. In the present experimental study free tendon grafts were nourished by synovial fluid only. By morphological and cytochemical techniques viable cells were found in the superficial zones of the tendon, capable of both proliferation and production and production of new collagen. This repair process affected predominantly the ends of the grafts. At the centre of the specimens degenerative changes appeared to an increasing extent throughout the observation period of 12 weeks. Adhesions to the surrounding tissues did not form. It is concluded that fibroblasts, most probably originated from the superficial cell layers of the tendon are capable of regeneration and synthesis of new collagen and that synovial fluid plays an important role in the metabolic exchange of the superficial scantily vascularized areas of the tendon. The observations are discussed in relation to the present concepts of tendon surgery.


[Myxochondrosarcoma of the hand].

[Myxochondrosarcoma of the hand]. First description of repeated recurrence of a myxochondrosarcoma of the second metacarpal, most probably beginning as a central chondrosarcoma and within few months, after destroying the cortex, spreading into the soft tissues as a myxosarcoma. As it consisted mainly of chondroid material it is to be classified as a chondrosarcoma while histologically it showed small spindle cell and angiomatous areas. The rarity, pathological anatomy and clinical therapeutic experience with chondrosarcoma oft the hand with its greater tendency to metastasize from there than from other locations are discussed. The morphological differences between the common secondary myxoid degeneration of chondrosarcoma and the rare primary myxosarcoma are accentuated.


[An accessory muscle and additional variants of the forearm]. A report is given on an accessory muscle of the forearm. The muscle originates from the medial epicondyle and the fascia of the forearm and inserts into the pisiform bone and retinaculum. The accessory muscle has a great similarity with the flexor carpi ulnaris muscle.


[The carpal tunnel syndrome. Indication, technic and results following epineural and interfascicular neurolysis]. In the advanced stage of the carpal tunnel syndrome with apparently "irreversible" loss of motor function and sensibility, epineural and interfascicular neurolysis has been recommended as an idjunct to the conventional decompression of the median nerve. Nevertheless the literature is lacking in data concerning recovery of motor function after operation. In addition to clinical examination, histological and electromyographic data are proveded to demonstrate the histo-pathological changes and the late results after neurolysis. Indications for the technique of this more radical operative procedure as well as late results are described.


[Rupture of the distal biceps tendon and its treatment]. Rupture of the distal tendon of the biceps muscle is an uncommon injury. It mostly happens to strong men whose biceps muscle are contracted and overstretched unexpectedly. Contrary to the good results after conservative treatment of the numerous ruptures of the proximal tendons the distal tendon must always be surgically reconstructed. Three cases of rupture of the distal biceps tendon are reported and their good results are shown following an modified operation originally described by PLATT.


Malignant neuroleptic syndrome--its present status in Japan and clinical problems. Fourteen cases in which hyperpyrexia, akinesia, mutism, extrapyramidal symptoms and severe, diverse autonomic symptoms developed in the course of neuroleptic drug therapy are reported as the malignant neuroleptic syndrome, with analysis and discussion of the clinical features and pathogenic factors. Possible factors contributing to the danger of evoking this syndrome are: 1. Physical exhaustion associated with dehydration, and 2. Parenteral administration of neuroleptic agents, especially of the incisive type. Symptomatologic similarity of the syndrome to the condition known as malignant hyperthermia during anesthesia is also discussed.


Monoamine oxidase activity in blood platelets from autistic children. In order to evaluate the possible abnormality in monoamine oxidase (MAO) activity in early infantile autism, blood platelet samples were obtained from 20 autistic children, aged 2--12 years. MAO activity, measured fluorometrically using serotonin as substrate, was 5.24 +/- 1.65 (Mean +/- Standard Deviation) nM/MG protein/hour in these autistic children. This value was not significantly different from either that in 30 age-matched normal children or that in 39 nonautistic children with various psychiatric and neurological disorders, although autistic children had higher platelet serotonin concentration than these nonautistic individuals.


Capgras phenomenon in a case of temporal lobe epilepsy. The present report regarda a patient of temporal lobe epilepsy, who developed the classical features of Capgras phenomenon. The whole clinical picture responded to treatment. The possible roles of organic and psycho-social factors in the psychopathology of this peculiar delusion in this patient are discussed.


Delta component variations in human sleep electroencephalogram. All night sleep was recorded polygraphically on 14 healthy adults, once for each person, and EEG was analyzed with bandpass filters. The integrated values during successive 10 second epochs were recorded consecutively at 1 mm intervals, separately for each frequency band. The variations of integrated values for long time span were clearly observed. The findings on 1-2 Hz component are reported exclusively in this report. (1) Four variation patterns were classified on the variations of integrated values of 1-2 Hz band component; long undulation, short undulation, irregular undulation and slight fluctuation. Short undulation was superimposed on long undulation. Long undulation had a gradually increasing slope, a plateau and steeply decreasing slope. Irregular undulation showed generally irregular fluctuations, without any definite variation patterns. During slight fluctuation the variations were small. Long undulation and irregular undulation corresponded to slow-wave sleep and slight fluctuation corresponded to REM sleep. The mean duration of each long undulation and irregular undulation was 31.2 and 11.9 minutes, respectively. In long undulations, 62.8% of the time was occupied by Stage 2 and the lesser ratio by Stages 3 and 4. In irregular undulation 89.1% of the time corresponded to Stage 2. (2) One sleep cycle was composed of the three sleep states which were accompanied with variation patterns, long undulation, irregular undulation and slight fluctuation. The sequence of the appearance of the former two patterns in one sleep cycle was classified into four types. About half of the sleep cycles in all records exhibited Type 1; the pattern started with long undulation, after one or several long undulations followed by irregular undulation and proceeded to slight fluctuation. The average number of long indulation in one sleep cycle was 1.58. (3) On all records, the highest long undulations appeared in the first cycle of all night sleep, in both frontal and central areas. In the occipital area, some of the highest crests appeared in the second cycle. When the highest of long undulations appeared, the height tended to decrease prior to wakening. The crest line of long undulation in frontal and central areas crossed in the latter period of all night sleep, in five controls. The mean voltage of long undulation in frontal, central and occipital areas was 52.4, 42.5 and 23.5 microvolts, respectively. The underlying physiological mechanism of delta waves in human sleep EEG and possible brain structures essential for long undulation and irregular undulation were discussed from both the clinical and experimental aspects.


Effects of manganese, calcium, magnesium and lithium on the ouabain-induced seizure. The effects of the intraventricularly administered cations (Mn2+, Ca2+, Mg2+ and Li+) against the seizure induced by ouabain (3 microgram) were investigated. Mn2+, Ca2+ and Mg2+ caused definite sedation and decreased locomotor activity. But Li+ was without significant behavioral effect at the doses applied. Among the cations used, Mn2+, Ca2+ and Mg2+ showed significant anticonvulsive effect on the ouabain-induced seizure. In comparison, on the dose and molar-to-molar basis, the potency of anticonvulsive action was in the following order: Mn2+ greater than Ca2+ greater than Mg2+. On the contrary, the higher dose of Li+ potentiated the ouabain-induced seizure. The importance of the increased Ca2+ level in the extracellular space or the inhibition of Ca2+ uptake as the anticonvulsive effect of Ca2+, Mn2+ and Mg2+ was discussed.


Biological properties of goat immunoglobulins G. Ther serum concentration of normal adult goat total IgG was established to be 19.97 +/- 1.55 mg/ml, the IgG1 10.92 +/- 0.84 mg/ml and IgG2 9.07 +/- 0.78 mg/ml. No significant variations were found to be associated with the seasons of the year but changes in concentration, especially in serum IgG1 occur ante- and post-partum. In goat colostrum, the IgG concentration is about 2.4-2.8 times greater than in serum and the IgG1 subclass accounts for 95-98 per cent. During the immune response the IgG1 rises sharply whereas variations in IgG2 concentration are less evident. Both IgG subclasses are active in haemagglutination, although the IgG1 is 22-52 times more efficient. As in all ruminants, only IgG1 fixes complement in the classical test. Differences exist between IgG subclasses in their ability to induce PCA reactions. IgG2 subclass is active only in homologous species whereas the IgGl in heterologous species. Cytophilic activity is associated with IgG2 subclass.


Immune mechanisms to Ascaris suum in inbred guinea-pigs. I. Passive transfer of immunity by cells or serum. Syngeneic Strain 2 guinea-pigs which received seven s.c. injections of infective eggs of Ascaris suum were shown to harbour less larvae in their lungs than control animals after mesenteric vein challenge with 10,000 infective larvae of A. suum. Serum and cell preparations harvested from these animals were able to transfer protective immunity to normal recipients to varying degrees. Significant protection with serum preparations was obtained with immune IgG2, IgE + IgG1 and whole immune serum. Best protection with cell preparations was obtained with a pool of cells from the mesenteric, hepatic (retropancreatic), and mediastinal nodes of immune animals. Cells from the hepatic nodes of immune animals were more effective than cells from the mediastinal and mesenteric nodes. Immune spleen cells enhanced, rather than reduced, the degree of the infection. Cells or serum preparations from normal animals were not capable of transferring portective immunity to normal recipients.


Immunoglobulin-containing cells in different lymphoid organs of the CBA mouse during its life-span. The number of cells containing cytoplasmic immunoglobulin (C-Ig cells) was determined in the spleen, mesenteric lymph nodes, bone marrow and Peyer's patches of CBA mice of different ages. A rapid increase in the number of C-Ig cells at between 2 and 6 weeks of age was observed in spleen and gut-associated lymphoid organs. The absolute number of C-Ig cells in these organs decreases with advancing age. In the bone marrow, the number of C-Ig cells increases steadily with age up to one year. From one year on, the number remains approximately constant in the males. In female mice, the number of C-Ig cells, mainly of the IgA class, increases sharply around 1 year of age. The spleen is the major site of Ig synthesis up to about 6 months of age. In older animals, the relative contribution of the bone marrow increases with age, possibly due to a gradual shift in the individual animal from primary type responses to a pattern of secondary type responses. No indication of a decreased overall immunological activity in senescence was obtained.


The properties of immune complex-forming systems. A new theoretical approach. A new mathematical model for antigen-antibody interactions has been developed. The new model is based on the assumption that the formation of complexes between a bivalent antibody and a multivalent antigen is determined thermodynamically by the concentrations and valences of antigen as well as antibody, together with one association constant which is common to all mutual interactions. Formulae have been derived for calculation of the distributions of compositionally different antigen-antibody complexes either from knowledge of equilibrium concentrations of free antigen and antibody, or from knowledge of total amounts of antigen and antibody in the system. A computer program for these calculation is described. The model is found to yield precise predictions of the formation of soluble immune complexes, as studied by zonal centrifugation. It is found through use of the model that 'complex formation' as such differs in binding characteristics from adsorption, especially for high concentrations of antigens and antibodies. 'Complex formation' implies that association constants estimated through a Sips plot method will vary with antibody concentration, and that certain curvatures of the lines in a Sips plot reflect inherent properties of complex-forming systems.


Nippostrongylus brasiliensis infection in rats. The cellular requirement for worm expulsion. The expulsion of antibody-damaged Nippostrongylus brasiliensis nematodes from the intestine of rats irradiated with 750 rad 60Co was induced by thoracic duct lymph (TDL) or mesenteric lymph node (MLN) cells apparently without the help of bone marrow-derived cells. The effector cells were present in the TDL or MLN of rats by the 8th day after infection and could be recovered from the peritoneal cavity. The ability of TDL cells to transfer immunity to irradiated recipients was undiminished when the cells with immunoglobulin on their surface were removed. These results suggest that, following antibody damage, this nematode is expelled by nonimmunoglobulin-bearing lymphocytes which are effective in the absence of newly formed cells derived from the cell recipients.


Immunoglobulin expression and synthesis by human haemic cell lines. Twenty-six human cell lines derived from a variety of lymphoid and non-lymphoid malignancies, were investigated for their immunological markers, with special reference to the class of immunoglobulin expressed. Twenty-five of the lines stained positively for surface immunoglobulin and IgD together with IgM proved to be the major immunoglobulin classes on these cells. Six of the lines were chosen for a study of their immunoglobulin synthesis patterns over an 18-h period and the immunoglobulin produced was analysed on SDS-polyacrylamide gel electrophoresis. Patterns obtained from the cell lines were similar to that from normal lymph node lymphocytes and differed markedly to plasma cells. Two of the cell lines had abnormal immunoglobulin synthesis patterns characterized as free light chains in one case. The cell lines are evaluated for their usefulness as models of immunoglobulin synthesis and analogues of normal and neoplastic states.


Antigenic competition in the induction of contact sensitivity in mice. Antigenic competition in contact sensitivity was found to occur between DNFB and PCl and also between some other pairs of non-cross reacting sensitizers. When mice were painted with DNFB 0-7 days before the sensitization with PCl, the responsiveness to PCl was suppressed completely, whereas when DNFB was painted after sensitization with PCl, the responsiveness to PCl was affected. The prior application of DNFB resulted in the reduction of DNA synthesis in the draining lymph nodes of PCl-sensitization. This indicated that the suppression by painting with DNFB was not attributable to the inactivation of PCl-specific effector T cells which had already been generated by the sensitization with PCl, but to the inhibition of the generation of PCl-specific effector T cells. The antigenic competition occurred even when two contact sensitizing agents were applied to different lymphoid regions of mice. The suppressive effect of DNFB on the PCl-sensitization was observed also in the mice which had been made tolerant to DNFB. These results seem to imply that the antigenic competition in the present experimental system is the phenomenon which may not be mediated by effector T cells but rather by other cells, possibly suppressor cells.


Suppression and potentiation of expression of delayed-type hypersensitivity by dextran sulphate. Dextran sulphate delays the onset, or even completely suppresses the expression in mice of DTH or SRBC when administered via a route different from that of eliciting antigen. However, DS injected together with the eliciting antigen potential the expression of DTH. Dextran showed no effect on DTH. Cell transfer experiments suggest that the targets for the action of DS are the accessory cells (monocytes) and not the T-effector cells. As shown, using polystyrene latex particles and lipopolysaccharide from E. coli, trapping and perhaps activation of the trapped accessory cells rather than toxic effects of DS are responsible for these phenomena.


The influence of IgE-mediated reactions on the expression of delayed hypersensitivity in the rat. The effect of IgE-mediated reactions on the expression of delayed hypersensitivity skin reactions was examined in the rat. It was found that the elicitation of an IgE-mediated reaction at the time of skin test could either potentiate or inhibit the development of delayed reactions. At a fixed level of IgE sensitivity, large delayed reactions were potentiated and small delayed reactions suppressed. These interactions were not dependent on the two types of sensitivity being direct against the same antigen but were dependent on the reaction of IgE with its appropriate antigen.


In vitro inhibition of human peripheral blood lymphocyte transformation by an extract of Pseudomonas putida. An extract prepared from a psychrophilic strain of Pseudomonas putida was found to cause a dose-dependent inhibition of [H3]TdR incorporation into human peripheral blood lymphocytes stimulated with PHA, ConA, PWM, or in a mixed lymphocyte reaction. The inhibition was found not to be the result of cytotoxicity, culture medium depletion of a component necessary for lymphocyte transformation, or interference with label uptake by blast lymphocytes. The extract was most effective when added prior to 48 h of mitogen stimulation. The inhibitory material was photeolytic enzyme degradable, heat-stable and non-dialyzable.


Immunosuppression in murine malaria. II. The primary response to bovine serum albumin. The primary antibody response to alumadsorbed bovine serum albumin was depressed in CBA mice infected with Plasmodium yoelii yoelii. Responses initiated within approximately 3 weeks of this malaria infection were reduced in quantity, but not in avidity. Responses initated later were normal. A depressed primary response was also seen in infected compared to control splenectomized mice; this was accompanied by impaired  priming for a secondary response.


The United States drug problem and international trafficking. Part II. Denial of safe-havens to illicit drug traffickers. Excessive reliance on extradition as a means of acquiring prosecutional control over illicit drug traffickers is short-sighted. Informal arrangements, like expulsion, should be given more consideration. A method for developing a unified antitrafficker policy and for implementing that policy through existing diplomatic channels is demonstrated through the use of the safe-haven deprivation/deterrence model. This paper focuses on drug traffickers. Trafficking is a function of the availability of both suppliers and consumers. Other available forms of cooperation within the United States government to induce foreign states to assure that opium crops are either destroyed or controlled within licit user channels should not be overlooked.


Life stress as a precursor to adolescent drug dependence. Though drug dependence is often characterized as a stress-produced disorder, there seems to be little or no quantitative data relating stress and drug dependence. In this study a recognized instrument for the measurement of stress, Coddington's Life Event Record, was administered to 31 drug-dependent adolescents by estimating levels of life stress during the year preceding their first illicit drug use. The drug-dependent subjects showed significantly higher life stress scores than did a standard normal population of adolescents. The null hypothesis of no difference was rejected at the .005 level. A stress-reduction theory of drug dependence gains support from these results.


Medical students and drugs: further neuropsychological and use pattern considerations. Drug use patterns of 134 freshman medical students were surveyed. Ninety-four percent reported experience with alcohol, 72% with marijuana, 24% with hallucinogens or stimulants, and 7% with opiates. Persons who reported use of the least socially sanctioned substances (hallucinogens, stimulants, opiates) were a subgroup of marijuana users, whereas marijuana experienced students were a subgroup of alcohol users. Increasing marijuana use appears to be associated with increased alcohol consumption. Twenty-five students who had never used marijuana and 26 students who had used it on 50 or more occasions were compared on three neuropsychological tests: Tactual Performance Test, Minnesota Perceptuo-Diagnostic Test, and the Hutt Adaptation of the Bender Gestalt Test. There were no neuropsychological differences between marijuana experienced and marijuana naive subjects. The methodological difficulties in studying the long-term cerebral effects of marijuana are discussed.


Factors related to successful retention in methadone maintenance: a review. This paper discusses patient demographic and psychological characteristics as predisposing factors, and dose size and availability of alternative treatment systems as treatment variables in determining length of stay at MMTPs. In general, there is considerable evidence that predisposing factors and treatment variables interact in affecting retention rates. The implications of this interaction for research in MMTP effectiveness are discussed.


Professional thieves and drugs.

Professional thieves and drugs. The "professional thief" is a highly specialized predatory offender with a history that dates back to Elizabethan England. Although this type of criminal is generally associated with narcotic addiction, his drug-taking typically involved the use of heroin, morphine, and cocaine on an intermittent basis. However, trafficking in drugs was common to the "professional" underworld, and as a result this deviant fraternity had a notable impact on the impressment of a criminal model of drug use on twentieth century conceptions of the addict. The concept of "professional" theft is reviewed, the use of drugs by professional thieves is discussed, and the interaction between this underworld group and the early Federal Bureau of Narcotics is examined.


Heroin use among soldiers in the United States and Vietnam: a comparison in retrospect. A "unique" heroin epidemic was claimed to exist among American soldiers in Vietnam in the early 1970s. To assess this claim, in 1972 we simultaneously evaluated heroin use in two similar military populations in the United States and Vietnam and compared findings with previous Vietnam studies. The total percentage ever reporting use of heroin was comparable in both locations. Recent use, however, was significantly higher in Vietnam. Heroin users, regardless of location, were demographically and psychosocially more similar than different. Any conclusion that the heroin epidemic in Vietnam was grossly "unique" seems unwarranted.


Drug abuse in South Carolina: comparison with three studies. This report discusses results of a state study on drug abuse in South Carolina and compares them with those of a similar state study conducted the previous year, as well as with three national studies. Since the latter did not deal with all the specific aspects of the state study, only the relevant portions are compared. The first of the national studies is on assessment of the diffusion of heroin abuse to medium-sized American cities. The second is on teenage drug abusers admitted to treatment. The third is on students and drugs in colleges and high schools.


English schoolchildren and illegal drugs. I. Levels of familiarity with drugs. Questionnaires were given to groups of fifteen and sixteen-year-old students in 29 schools in various parts of England, and their reported familiarity with illegal drugs is presented here: those students who have no drug-using acquaintances, those who have such acquaintances but have never been offered an illegal drug, those who have had offers and rejected them all, and those who have ever accepted an offer are distinguished. Levels of acceptance of illegal drugs, which averaged 10.5% across the schools sampled, are compared with levels found in other English surveys. It is concluded that levels of familiarity with illegal drugs varies so much from school to school that attempts to establish a national average figure would not be useful for predicting levels of familiarity in any particular school. Part II of this paper, forthcoming, will discuss changes over the 1-year period 1973-1974.


Comparison of the effect of high and low doses of methadone on treatment outcome. The results of a 2-year-study of the relationship between methadone dosage and treatment outcome are reported. For discharged patients, higher doses of methadone were significantly related to successful treatment and lower doses to treatment failure. Based on these findings and the review of literature as well as the senior author's clinical experience, a theoretical formulation is offered to provide a rationale for methadone maintenance treatment. The tenability of the formulation is readily testable by clinical research.


Sampling survey on brucellosis among farmers and their families in Ille-et-Vilaine (Brittany). A three-stage sampling survey among farmers and their families living on farms in the department of Ille-et-Vilaine gave the following results: Among 490 persons examined 313 (64 per cent) showed a positive skin test and 105 (21 per cent) a positive serological reaction; 88 of the 105 patients ignored their health status, although 45 of these presented clinical symptoms (nine per cent). This survey is continuing in order to study the non-respondents and to better analyse the epidemiological situation at a farm level.


Alcoholic cirrhosis of the liver in the Scandinavian countries 1961-1974. The increase in mortality from alcohol induced cirrhosis of the liver in Sweden, Norway, Finland and Denmark from 1961 to 1974 is compared. Mortality from alcoholic cirrhosis of the liver increased in Finland and Denmark tenfold and fivefold respectively from 1961 to 1974. The increase has been particularly marked since 1968. In Sweden a threefold increase and in Norway a doubling of mortality in males was ascribed to alcohol induced liver cirrhosis. Mortality from non-alcoholic cirrhosis of the liver remained practically unchanged during the period. Increases in mortality from liver cirrhosis due to alcohol abuse run parallel with increases in alcohol consumption; the countries with the highest mortality have the highest consumption. The distribution of consumption of beer, wine and spirit is compared in the four countries: consumption of spirits predominates in Sweden, in Finland spirits and beer, in Denmark beer and wine and in Norway spirits and beer. Doubling of alcohol consumption in a country is followed by a fourfold increase in the number of addicts, and fourfold increase in alcohol induced diseases.


A controlled trial of multiphasic screening in middle-age: results of the South-East London Screening Study. The South-East London Screening Study Group. The results of a controlled trial of multiphasic screening in general practice are presented. In 1967, 7,229 individuals aged between 40 and 64 years were randomly allocated into either a Screening or Control group. The Screening group were invited to attend two screening sessions held about two years apart, while the Control group continued to receive conventional medical care. Both groups were then invited to undergo a health survey in 1972-73 which revealed no significant differences in morbidity between the two groups. Careful follow-up permitted detailed Screening-Control comparisons of various outcome measures--consultation and hospital admission rates, certified sickness absence from work, and mortality. Nine years after the initial screening, no significant differences were found between the two groups in any of the outcome measures. It is estimated that a similar screening programme for the entire middle-aged UK population would cost 142 pounds million at 1976 prices.


Risk factors of breast cancer in Finland. The risk of breast cancer in Finland is low (40.1/100,000) compared with the other Nordic countries. A case-control study was carried out on 122 cases of breast cancer and 534 controls between the ages of 41 and 60. It was found that age at first marriage and birth of the first child as well as the number of abortions and parity adjusted for age at first birth were associated with the breast cancer risk, whereas lactation was not. The results did not confirm the hypothesis (de Waard) that overweight and/or the size of the woman influence the risk of breast cancer.


On allowing for diagnostic imperfections in assessing effectiveness of treatment for Schistosomiasis. Some possible effects of misdiagnosis for Schistosomiasis in epidemiological measurements are investigated. With greater chances of misdiagnosis for lower prevalence levels, expectations of control programmes might be reassessed. As prevalence decreases, the fraction of missed positives over all apparent negatives need not uniformly decrease. In control situations even perfect treatment rates may produce very small changes in prevalence and other indices of infectivity level.


Paths of association in epidemiological analysis: application to health effects of environmental exposures. Conventional regression analysis is based on assumptions of bidirectional associations between pairs of independent variables. In a number of circumstances these assumptions are not plausible. Structural representation in conventional regression is based on a set of parallel paths between independent and dependent variables; when the implausible assumptions are excluded, a different structrual relation between the independent and dependent variables is found. It permits a series associative path between independent variables. Two criteria for modification of conventional multivariate analysis are presented. They are when bilateral symmetry among independent variables is implausible on the basis of a priori information, and when there are significant differences between zero order and first order partial correlation coefficients. When these criteria are applied, there may result a series-parallel matrix of associations. For analysis of such a matrix, the procedures of path analysis are appropriate. The concepts are illustrated with environmental examples, and path analytical computations are worked out for a set of data on social and environmental factors which affected infant mortality in England and Wales between 1928-1938.


Running amok.

Running amok. This study examines twenty-four cases of amok, believed the largest number of cases ever collected. They were observed in Sarawak, East Malaysia. They occurred in all indigenous groups in Sarawak, excluding the Chinese, such as Malay, Sea Dayak, Land Dayak, Kayan, Punan and Melanau at frequencies more or less following the proportion of these groups in the total population. No differences were found according to religion, the Malay being Muslim and the other groups either predominantly Christian like the Iban or animistic. Only slight diminution in the frequency was observed from 1954 to 1968. The education level of the amok runners was much lower than that of the average population. The weapons used were those immediately at hand be it parang (short sword), ax, sticks, knives, guns, bare hands or a lorry. The classical four stages were largely present: (a) brooding and withdrawal, (b) homicidal paroxysm, (c) continuation of homicidal behaviour until killed, restrained or falling into stupor of exhaustion, (d) complete or partial amnesia. While in 14 no motive could be ascertained, insult, jealousy and paranoid ideation was present in the others. Both family history of mental illness and personal psychiatric history were predominant. All cases fell into accepted diagnostic categories from organic and endogenous psychosis to neurosis and behaviour disorder.


Community psyciatry in Nigeria--the current status. Over a period of 50 months, 512 psychiatric patients were treated in the Aro Village therapeutic community. The majority of those admitted (94.1%) had symptoms of psychosis. By the end of three months 57.8% had been discharged, while 88.9% were discharged by the end of five months. Of these, 70.3% were judged fit to return to their work. The relatives of patients as well as the villagers were involved in the treatment programme. The advantages of this method, are discussed, as well as the implications for the future of the programme of the loosening of traditional family ties resulting from rapid urbanisation.


Teaching psychiatry to medical students on a consultation service. Medical students experience psychiatric consultation as part of their undergraduate psychiatric clerkship experience. This allows further identification of the medical student with the psychiatrist in management of psychiatric problems in patient who are primarily non-psychiatric. Reaction has tended to be favourable from the medical students without a great loss of speed or efficiency in terms of the service committment.


Urolithiasis associated with hypercalciuria. Fifty male patients with urolithiasis (UL), associated with idiopathic hypercalciuria (IH), were studied in comparison to a group of 18 male normocalcemic patients with inactive calcium stone disease of unknown etiology. In the group of IH-UL, in addition to hypercaliuria, statistically significant hyperphosphaturia with decreased tubular reabsorption of phosphate and hyperuricemia were observed; there was a tendency to hypophosphatemia although non-significant. In 36% of the IH-UL patients the first episode of renal colic appeared at age 40 to 50. Thirty-eight per cent of the IH-UL patients had recurrent stone formation. Twenty per cent of the IH-UL patients had a family history of urolithiasis. Forty-six per cent of all stones contained oxalate in addition to calcium, and 25% of the stones contained oxalate and phosphate.


Vesico-ureteral reflux and uninhibited neurogenic bladder. Ureteral reflux in female patients who also have latent uninhibited neurogenic bladder occurs synchronously with uninhibited contraction, is blocked by buscopan and is aggravated by besacholine. Intrinsic neuromuscular antireflux mechanism of the vesicoureteral junction (VUJ) appears to be affected by unknown ways with uninhibited contraction. Urethrovesical reflux observed synchronously with uninhibited contraction seems to play an additional role in the genesis of urinary infection. A different look is required in the management of these refluxes, in that concomitant use of the anticholinergic drugs is recommended in addition to the conventional approach for the control of infection, reflux and voiding symptoms.


Cancer of the urinary bladder and pyelonephritis. Successful treatment of cancer of the urinary bladder consists not only in elimination of the tumour process, but also in prophylaxis of various complications. Among complications caused by the tumour process as well as by the applied methods of its therapy a certain place belongs to pyelonephritis. Pyelonephritis develops in consequence of the disturbance of the function of the urinary bladder after hemicystectomy resulting from the change of the bladder's form. With the view of preserving the anatomo-physiological function of the urinary bladder and preventing complications the author suggests a method of reconstruction of the bladder consisting in shaping it in a spherical form after hemicystectomy. Such shape of the urinary bladder ensures nearly normal conditions for both urination act and urinary flow from the upper urinary pathways, this being the prophylaxis of pyelonephritis.


Experiences in treating cancer of the bladder. Experience in the treatment of urinary bladder cancer based upon observation of 306 cases has been presented. Two hundred and thirteen patients were treated surgically by performing in 151 cases partial cystectomy and in 62 cases total cystectomy. Conservative treatment was applied in 75 patients. In the authors' opinion the best method of treating bladder cancer is its radical excision. A simple and easy method of implantation of the ureters into the rectum is described.


Experimental studies on factors causing acute serum sickness glomerulonephritis of immune complex origin. I. The role of immune complexes and the immunological status of the host. In acute serum sickness glomerulonephritis induced in rabbits by large doses of BSA, the relationship of the host's immunological status and the severity of renal histological changes was studied. It was found that good antibody producers developed more severe renal lesions. The higher avidity of antibodies enhances the inflammatory effect of immune complexes. Kidney is favoured for deposition of immune complexes especially in the case of chronic immune complex formation in the presence of antigen excess. Diminished phagocytic function of leukocytes (probably decreased immune complex saturating capacity) may also contribute to the severity of renal histological alterations.


Experimental studies on factors causing acute serum sickness glomerulonephritis of immune complex origin. II. Pathomorphological analysis. Seventeen rabbits were given a single, large dose of bovine serum albumin (BSA) intravenously. Percutaneous kidney biopsy was carried out on the 14th and 31st days after BSA administration. Proteinuria was measured and the glomerular changes were analysed in order to find a correlation between the degree of proteinuria and glomerular alterations, i.e. number of electron-dense deposits (EDD), polymorphonuclear leukocytes (PMNL), and mononuclear marcophages (MNM). The results speak in favour of the decisive role of mononuclear macrophages in enhancement of glomerular permeability.


Meta-echinococcal arthrosynovitis: a clinical, anatomical and pathological entity not previously recognised. The authors describe a case of echinococcosis of the tibia which occurred twice in seven years, the first time with signs of active involvement of the knee joint. Certain special aspects of articular echinococcosis, not up to now reported in the literature, are dealt with. The conclusion reached is that in an articular site the parasite can give rise either to a veritable "echinococcal" arthritis or, as in the case presented, to a the synovial affection which cannot be defined as "echinococcal" because the synovium did not contain living larval forms of the parasite, but only microscopic chitinous inclusions, arising from the disintegration of sterile hydatids, which had escaped from the adjacent bony focus into the joint. The synovium reached to their presence with an intense inflammatory response of a predominantly histiocytic nature. The term "meta-echinococcal arthrosynovitis" is suggested as a more accurate designation of this syndrome.


The incidence and early detection of spinal deformities. A study based on the screening of 16,104 schoolchildren. Screening for spinal curvature (scoliosis and kyphosis) was carried out on children aged six to fourteen at schools in the Lazio region from 1972 to 1976 and this revealed a significant incidence of deformities. Out of 16,104 children examined, 1,163 (7.2 per cent) were affected by scoliotic or kyphotic curves. Of these, 56.5 per cent were scoliotic and 43.4 per cent were kyphotic. The female/male ratio in cases requiring orthopaedic or surgical treatment was 3.7:1. Of the total number of cases examined (16,104) the percentage of slight deformities requiring only physiotherapy or exercise treatment was 6.3 per cent (1,016 cases). 0.85 per cent (137 cases) required conservative orthopaedic treatment (plaster and corset), while 0.06 per cent (ten cases) required operation. This investigation is the first step towards the early diagnosis and treatment of vertebral deformities in Italy.


Scaglietti's method for conservative treatment of simple bone cysts with local injections of methylprednisolone acetate. The results of 30 consecutive cases of simple bone cysts treated conservatively by intracystic injections of methylprednisolone acetate (MPA) according to the method of Scaglietti are reported. The injections were given under general or local anaesthesia in doses of 80-200 mgs repeated every 2 months up to a total of 2 or 3 injections, rarely more. The minimum period required for achieving a result is 6 months; but there is a continuation of radiographic improvement for 1 to 2 years. There is complete radiographic cure in about half the cases; in the others there is a substantial improvement which makes surgery unnecessary. We have used this method systematically for 3 years, and out of 42 cases only one required operation because of a displaced subtrochanteric fracture. There was a partial recurrence in one case after apparent radiographic cure. The patients' age does not seem to affect the result but we gained the impression that the effect of MPA is quicker and more reliable in younger patients. Although we do not understand the mechanism of cure in this method it has undoubted advantages over surgery.


D,L-Glyceraldehyde 3-phosphate breakdown in the presence of selenalysine. Selenalysine is more effective than lysine both on glyceraldehyde 3-P transformation into methylglyoxal and on subsequent methylglyoxal polymerization.


Experimental arthrosis from intra-articular vitamin A injection in the rabbit. Morphological and biochemical study: considerations on the pathogenesis of human arthrosis in relation to the experimental model. The key to the pathogenesis of arthrosis lies in the mechanism responsible for the initial lesions. In this experimental work the possibility of producing arthrosic changes is demonstrated by activating lysosomal chondrocytic enzymes by the intra-articular injection of Vitamin A in rabbits. On the basis of the experimental results the authors discuss the possible role that activation of the lysosomal hydrolytic enzymes might play in producing primary and secondary arthrosis in humans. They advance the hypothesis that this mechanism may be the common final step in the degradation of the articular cartilage, whatever the aetiological factor.


Gluteal fibrosis.

Gluteal fibrosis. The authors report a histological study of gluteal fibrosis, a disease which in the last few years has become a clinical entity in its own right. This condition is of more frequent occurance than the earlier reports seem to indicate. The salient point emerging from this investigationis that teno-fascial changes exist as well as changes in the striated muscle. These teno-fascial changes are clearly more striking and extensive and should be regarded as primary. They consist of fibrotic thickening of the whole teno-fascial component with regressive changes leading to pseudocystic cavities and eventually to substitution by fibroadipose or adipose connective tissue. The muscle changes, however, generally appear to be localised near the tendon and present the features of simple atrophy and patchy necrosis, also eventually leading to zones of fibrous or fibroadipose substitution. These findings, though not offering a complete explantation of the pathogenesis, justify the description of the syndrome as a primary teno-fascial fibrosis with secondary muscle changes.


Anatomical and radiographic study of arthrosis of the hip. Statistics. The most important points in this study of 147 patients with arthrosis of the hip are the following: 1. Unilateral arthrosis has a distinctive behaviour pattern. 2. There are migratory and non-migratory and non-migratory types. The most common migration is supero-lateral. 3. Arthrosis of the hip is a biological process which can be divided into four stages. 4. Narrowing of the joint space is focal. 5. Cysts are seen frequently on both the acetabular side and in the head of the femur. They form after the overlying cartilage layer has disappeared. 6. Six types of osteophytes are identifiable, the most common being in relation to the inferior aspect of the calcar or femoral head. 7. Acetabular dysplasia, evaulated by using parameters of measurement (acetabular angle, depth, slope of roof and Wiberg's CE angle) was present in over half of our cases of arthrosis of the hip.


[Aorto-ilio-femoral venous grafts (author's transl)]. A venous graft of the internal iliac-artery is necessary when endarterectomy is impossible, has failed or is contra-indicated owing to the poor state of the profunda femoris artery. However we prefer a dacron prosthesis to a saphenous autograft. A venous graft may be used alone or in association with another plastic procedure, in particular aortic thrombo-endarterectomy of the common iliac artery. The saphenous vein may be used as a by pass on the external iliac artery. The authors report 90 personal cases which illustrate their concept.


[Splenectomy for hematologic indications. Indications, early results (author's transl)]. In the light of their personal experience of 1,036 splenectomies, the authors review the hematological diseases which still require surgery, viz. certain hemolytic anemias, idiopathic thrombocytopenic purpura, Hodgkin's disease under certain conditions, and sometimes the splenic lesions in certain malignant blood diseases; they analyse their results. Thanks to close collaboration between hematologists and intensive care specialists, the mortality has been reduced to 1.35 p. cent and the morbidity to 3.46 p. cent which leaves 95.19 p. cent without any immediate postoperative complications. The late results depend on the initial disease process.


[Subacute cytosteatonecrosis of pancreatic origin. Surgical problem in 5 cases (author's transl)]. The authors report 5 cases of subcutaneous cytosteatonecrosis (Weber-Christian syndrome of pancreatic origin) and review 68 cases in the world literature. The skin, bone joint and general manifestations may appear without any clinical or radiological sign of pancreatitis. The rise in blood and urinary amylase and lipase, the skin lesions, the joint pleural and peritoneal effusions, orient the diagnosis towards the pancreas and suggest a full radiological arteriographic and echotomographic investigation. The pancreatic disease was pancreatitis in 50 cases, cancer in 18 cases. Too long a delay between the initial signs and the diagnosis may lead to early operation even in the absence of pancreatic signs. The cancer may still be limited and removable. The pancreatitis was in 18 cases a false cyst of the head in 2/3rds, whether obvious clinically or not. Operation led to its discovery usually but may miss the lesion which is then only discovered on autopsy. Removal or early by pass operations transform the prognosis which is otherwise fatal. Analysis of these cases illustrates well the problems of indication operative management and efficacy of surgery in a disease still relatively unfamiliar both to physicians and surgeons.


[Value of conservative methods in the surgical treatment of peptic stenosis of the oesophagus in adults (author's transl)]. Out of a series of 103 patients operated on for peptic stenosis of the oesphagus, we carried out 63 conservative operations, 29 by the thoracic route, 34 by the abdominal route. The operation consists of retrograde dilatation, by finger or by instrument, combined with an anti-reflux arrangement. Among the various technics of the latter, plicature of the fundus has proved the most effective. Gradually, the indications for the abdominal approach have become dominant, even if the cardia cannot be lowered. One may then use a sleeve on the gastric cone, which until now, in 23 cases has given excellent results. One may thus carry out by an extremely benign operation without any mortality, a surgical cure not only of supple stenoses, but also of certain tight fibrous stenoses, considered insuperable. Postoperative dilation was rarely necessary. The results of which some are 8 years old, seem stable in the vast majority of cases. The proportion of excellent results was 81 p. cent of the series. It was higher in the group of plicatures of the fundus where there were only two failures. No case of cancer was observed in the remaining oesphagus.


[Surgical problems of the primary sclerosing cholangitis (author's transl)]. The characteristics of the primary sclerosing cholangitis are a diffuse inflammation with fibrous thickening and narrowing of the biliar ducts. Two observations replying to strict characteristics are related. From attacks of angiocholitis, the disease generally progresses till a parmanent icterus and death occurs in a state of biliar cirrhosis. In the liver, the micro pathology consists in fibrous rings constricting the segmentary interlobular ducts. The diagnostic is mainly difficult and the prognostic is fatal in average time of 4 years of evolution althought we used corticoids that were administrated by local method as well as in the classical general way.


[Villous tumor of the doudenum (author's transl)]. Villous tumors of the duodenum are rare, but treatment may be problematic because of their association with invasive adenocarcinoma. One case of villous tumor of the duodenum is described and 44 others reported cases are reviewed. Diagnosis may be made by radiographic barium contrast evaluation of the duodenum, especially with the addition of air contrast hypotonic studies and by fibro-optic endoscopy with biopsies. 32 p. cent of villous tumors of the duodenum are associated with adenocarcinoma. Local excision is the treatment of choice for benign lesions. Duodenectomy or pancreatico-duodenectomy are recommended for tumors which include invasive carcinoma.


[Primary tumours of the mesentery. Study of four cases (author's transl)]. The authors report four cases of mesenteric tumour including one cavernous lymphangioma complicated by volvulus of of the small intestine and one angiofibroma, a benign solid tumour which is rarely encountered. They comment on the preoperative assessment, which is not always possible for these patients are often operated on as an emergency. Cysts are easy to remove, but solid tumours even when benign are much more difficult to remove.


Isoproterenol enhancement of peritoneal permeability. As peritoneal dialysis is inefficient enouth to be time-consuming and sometimes clinically ineffective, we have evaluated pharmacologic enhancement of peritoneal permeability. Peritoneal dialyses were performed in New Zealand white rabbits by instillation of 50 ml/Kg of isotonic dialysis solution of standard composition. Mean peritoneal clearance of creatinine was 0.60 ml/Kg/min and urea was 0.80 ml/Kg/min, each decreasing as intraperitoneal dwell was prolonged (by .011 ml/Kg/min or less). With 0.04 micrometer/Kg of isoproterenol administered intraperitoneally, clearances increased to 0.91 and 1.30 ml/Kg/min (p less than 0.01). When isoproterenol was added to the dialysis solution one hour or more before instillation, the increment in clearances was less. Instillation of dialysis solution 24 hours after addition of a higher dose of isoproterenol (0.2 micrometer/Kg) did not increase clearances above control. No effect of isoproterenol on bulk flow of water, associated with the osmotic effect of dextrose, was demonstrated. As peritoneal clearances increased, the ratio creatinine clearance: urea clearance did not decrease, consistent with increased peritoneal permeability as well as blood flow.


Kinetics of intermittent and continuous peritoneal dialysis. Relations were developed for clearance under both intermittent and continuous flow peritoneal dialysis. The theoretical prediction was compared with data from other investigators. A mass transfer characteristic of 52 ml/min per 1.85 liters of dialysate was determined for urea from Boen's single batch experiment. This number was used to calculate the value of clearance for intermittent dialysis versus rate of dialysate exchange. The calculated clearances are in good agreement with Boen's experimental results. The calculated urea clearances for continuous flow dialysis were compared with Shinaberger's data. The predicted curve is in reasonable agreement with the data although there is a rather large scatter of the points. Some possible explanations for the scatter are provided as a caviat for future experimental research. A theoretical comparison between intermittent and continuous flow clearances shows that the latter is more efficient, particularly at higher flow rates.


Scleroderma kidney disease: a therapeutic approach with nephrectomy and hemodialysis. A 49 year old black female patient with progressive systemic sclerosis (scleroderma), multiple organ system involvement, uremia and malignant hypertension, was treated with maintenance hemodialysis and bilateral nephrectomy. Bilateral nephrectomy controlled refractory hypertension and appeared to alter the natural course of systemic sclerosis.


Fluoxymesterone therapy in anemia of patients on maintenance hemodialysis: comparison between patients with kidneys and anephric patients. Nineteen patients with their kidneys and 11 anephric patients who were stable on maintenance hemodialysis received 20 mg a day of Fluoxymesterone. At the end of four months, there was a significant increase (p less than 0.005) in the mean hematocrit with a parallel increase in the hemoglobin level in both groups of patients. Concomitantly, we observed an increment of the red cell mass that was significant at the level of p less than 0.05. Blood transfusion requirements decreased significantly (p less than 0.1), independent of the presence or absence of kidneys. No changes in body weight, serum albumin, and serum cholesterol levels were observed. Secondary effects were hirsutism and hoarsening of the voice.


Microencapsulated charcoal hemoperfusion: a possible therapeutic adjunct in digoxin toxicity. Attempts to remove substantial quantities of digoxin by either peritoneal or hemodialysis, have been unsuccessful due to their low clearance rate. The present study determined the in-vivo clearance rate for digoxin of a single microcapsule of 300 gm of activated charcoal. The clearance rate was 55 +/- 5 ml/min (mean +/- SEM) in the first hour and 48.4 +/- 4 ml/min in the second; these values are approximately five-fold higher than with other dialysis techniques. No evidence of a post-dialysis rebound increase in serum digoxin levels was found, implying that peripheral tissues can rapidly release digoxin to the diminishing serum pool. Preliminary data obtained suggest a beneficial effect on arrhythmias and lowering of the myocardial to serum rate of digoxin after hemoperfusion.


Staphylococcus aureus bacteremia in hemodialysis patients. Fifteen male hemodialysis patients developed 21 episodes of S. aureus bacteremia. Infections involving vascular access were responsible for 65% of initial bacteremias. The arteriovenous fistula was the most prevalent type of access used, and thus was responsible for the majority of these illnesses. Phage typing indicated that recurrent episodes were due to reinfection rather than relapse. Complications included endocarditis, osteomyelitis, septic embolism, and pericarditis. One patient died of infectious complications. It is recommended that hemodialysis patients developing bacteremia due to S. aureus receive at least 6 weeks of beta lactamase-resistant antimicrobial therapy.


An in vitro comparison of recirculation in "Y" flow and coaxial flow single needle dialysis systems. A conventional "Y" type and a new coaxial dual-flow single needle dialysis blood access device have been compared with regard to blood recirculation in an in vitro model. The new coaxial flow design eliminates all sources of within needle recirculation, and effectively minimizes within fistula recirculation except at very low fistular flow rates. The striking recirculation resulting from countercurrent, placement of either needle in the fistula documents the critical importance of needle insertion concurrent with fistula flow. This in vitro study indicates significant advantage of the coaxial dual-flow single needle over the conventional "Y" type needle with respect to blood recirculation.


Acute hemolysis due to profound hypo-osmolality. A complication of hemodialysis. Acute hemolysis in maintenance hemodialysis patients is not a rare occurrence. Significant hemolysis is life-threatening and may be unrecognized because of nonspecific symptomatology. This paper reports observation of a severe hemolytic episode in a hemodialysis patient. The hemolysis was associated with a sudden drop in serum osmolality and profound hyponatremia, resulting from accidental dialysis against deionized water. Recognizing the condition and treating it promptly by dialysis with physiological dialysate are essential for patient survival.


Whatever happened to home hemodialysis?

Whatever happened to home hemodialysis? Advantages of home hemodialysis over center include better patient survival and rehabilitation, more patient convenience, decreased risk of hepatitis, and cheaper costs. Home dialysis places stress on the family and requires a great time commitment of the helper. Ninety-three patients began home dialysis training at our institution. Seventy-eight successfully completed training and five patients are still in training. Of the seventy-eight who completed training, fifty (64%) are still performing home dialysis for periods of from one month to 6 1/2 years. 10% received a kidney transplant, 13% died, and 13% have returned to a center for dialysis. Family stress was the major reason for return to a center in the ten patients who chose to do so. Even though home dialysis is superior to center dialysis, the percentage of patients being treated in the home in this country is diminishing. Possible reasons for this decline are discussed.


Future of home hemodialysis.

Future of home hemodialysis. An attempt to prophesy the future of home hemodialysis is based on anticipated near and long term technological improvements. Dialysis treatments will become shorter, due to pressure filtration, while extracting molecules in the 300 to 3000 dalton weight range through more permeable membranes. Portable and wearable dialysis systems will increase patient mobility. By the 21st century, implantable bionic kidneys and perfect host tolerance to renal allografts and xenografts will relegate home hemodialysis to history texts. A non-surgical definitive treatment for uremia is envisioned in the colonization of the human bowel with nitrogenn recycling bacteria.


Hemofiltration: treatment of renal failure by ultrafiltration and substitution. Hemofiltration, in contrast to hemodialysis or peritoneal dialysis, eliminates toxic substances accumulated in uremia by a process that is independent of molecular weight. By means of a special device, the ultrafiltrate of blood is replaced, up to the desired amount, by a modified Ringer's lactate solution. The application of this new method results in better control of severe hypertension, and controls calcium phosphate and lipid metabolism in a more physiologic manner than dialysis does, without additional drug therapy being necessary. Smaller amounts of fluid and a simplification of devices improve hygienic conditions and patient mobility.


Clinical aspects of hemofiltration.

Clinical aspects of hemofiltration. We report on clinical experiences obtained in 7 uremic patients treated since January 1976 3 times weekly by chronic hemofiltration. The observations which we collected in more than 300 treatments suggest that hemofiltration might be superior to conventional hemodialysis. The main advantages of this treatment are characterized by its better control of hypertension, hyperhydration, and possibly of uremic bone disease. Furthermore, the applied acrylonitrile membrane allows the removal of substances with a molecular weight up to 60,000, similar to the glomerular basement membrane. Additionally, we report on methodological problems, on the compatibility of hemofiltration, and finally on its efficiency for removal of different uremic solutes.


Influences of the site of diluting fluid substitution on hemodiafiltration processing. In hemodiafiltration, the diluting fluid can be substituted before or after the ultrafilter. The advantages and disadvantages of each method are discussed below. To avoid hemoconcentration when passing through the ultrafilter, we prefer substitution of the diluting fluid to blood before the ultrafilter and accept the greater composition of diluting fluid.


The hemofiltration system: variations of the negative pressure. The physical conditions of the hemofiltration process are briefly discussed to describe the applied system that is characterized by a negative pressure pump which is directly attached behing the filter. A schema is presented that shows the characteristics of a fully automatic hemofiltration apparatus that is presently in development.


Lipid metabolism in uremia: effect of regular hemofiltration and hemodialysis treatment. Plasma triglycerides and cholesterol were measured in controls, non-dialyzed patients with chronic renal insufficiency and uremic patients receiving either regular hemodialysis or hemofiltration treatment. Normal and elevated cholesterol levels remained generally unaffected by chronic hemodialysis and hemofiltration as well. Whereas long-term hemodialysis even up to 59 months (home-dialysis) was unable to improve hypertriglyceridemia, patients undergoing regular hemofiltration showed a prolonged decrease in plasma triglycerides. In one case, excessive hypertriglyceridemia still existing after five years of chronic hemodialysis could be normalized by hemofiltration.


Parathyroid hormone-, 25-OH-vitamin D-, and digoxin levels in patients treated by chronic hemofiltration. Immunoreactive parathyroid hormone (iPTH) was measured in the serum and filtrate before, during and after hemofiltration. iPTH regularly declines during hemofiltration; one patient, investigated for a longer period, showed a normalization of iPTH serum level with this treatment. The iPTH values found in the hemofiltrate were remarkably high, a finding that could be explained by non-specific effects, by the occurrence of hormone fragments or by an increased secretion rate. At any rate, the results suggest a filtration of parathyroid hormone and/or hormone fragments. On the other hand, it was impossible to detect any 25-OH-vitamin D in the hemofiltrate. Finally, digoxin could be found in the filtrate, but only in very low concentrations.


Parathyroid hormone, calcium and phosphate balance in hemofiltration. The acute changes in calcium, phosphate and parathyroid hormone have been examined in chronic renal failure patients under-going hemofiltration therapy and the results compared to a similar group treated by hemodialysis. In both groups there was a significant increase in Catot (0.32 mEq/1 for hemodialysis; 0.56 m Eq/1 for hemofiltration) with Ca++ remaining constant. Plasma phosphate and parathyroid hormone decreased during hemofiltration. Calcium balances were slightly positive and phosphate balances distinctly negative in all cases. To date there is no indication of induced osteodystrophy during hemofiltration therapy, although long-term studies are needed. However, the present results indicate, that hemofiltration more closely approaches the physiological situation than conventional hemodialysis.


Elimination of hormones through hemofiltration. The concentrations of testosterone, cortisone, gastrin, GIP, somatomedin B, insulin, HGH, and TSH have been determined in the plasma and the ultrafiltrate of five uremic patients undergoing intermittent hemofiltration treatment. There was a considerable loss of gastrin, GIP, somatomedin B, and insulin by hemofiltration treatment; the plasma concentrations, however, did not decrease. Cortisone, HGH, and TSH were not detectable in the ultrafiltrate. Our results therefore indicate that hemofiltration does not cause a hormone deficiency syndrome. On the contrary, the loss of degradation products of hormones with disturbing biological activity may be a favourable effect of the hemofiltration treatment.


Evaluation of a new disposable plate dialyzer and the adverse effect of recirculation single pass dialysis on clearance. A new disposable plate dialyzer (PF = Travenol Paraflo 1.0 m2 11.5 mu Cuprophan), is compared with an older device of similar design (GL = Gambro Lundia Nova 1.0 m2 13.5 mu Cuprophan). The ultrafiltration rate (UF) relative to dialyzer pressure (DP) was greater for GL (3.90 +/- .02 DP ml/min) than for this lot of PF (2.71 +/- .01 DP ml/min). In vivo clearance of urea and creatinine in single pass for PF was 132 +/- 5 ml/min and 106 +/- 5 ml/min, respectively, at mean blood rate of 200 ml/min. RSP produced significantly lower urea and creatinine clearance (p less than .005, less than .025). These values were not significantly different from those for GL. Decrease in patient BUN and plasma creatinine during dialysis corroborated the clearance data. SP operation of these plate dialyzers is recommended since the disadvantages of RSP outweigh its advantages.


Physiologic response patterns to occlusion of clinically significant arteriovenous fistulas. Seven patients with hemodynamically significant arteriovenous fistulas for dialysis angioaccess were studied by multivarient computer analysis of physiologic data derived from cardiogreen dye dilution curves and A-VO2 before and after acute occlusion of their fistulas and prior to clinical therapy. Three patterns of response were characterized. These patterns seemed to be related to the innate ventricular contractility status, the type of medications, the presence of autonomic neuropathy, and their interplay with alterations in preload and afterload with fistula occlusion. In one patient, the response pattern precluded banding or occlusion of the fistula. In the remainder, the physiolobic responses permitted treatment by banding or occlusion. It seems advisable to adequately evaluate the physiologic response patterns of patients with hemodynamically significant arteriovenous fistulas prior to definitive treatment.


Drug elimination by hemofiltration.

Drug elimination by hemofiltration. Elimination by hemofiltration of gentamicin, doxycylin, ampicillin, sulfamethoxazole and clofibrate was measured in patients with chronic renal insufficiency. Clearance values of ampicillin and clofibrate were roughly in the range that might be expected according to the reported protein binding values of these drugs, whereas doxycyclin and sulfamethoxazole were eliminated to a much higher degree. Gentamicin clearances during a 6-hour hemofiltration treatment were lower than should be expected from reported protein binding values. For gentamicin and doxycyclin the filtered fraction linearly increased with time, a phenomenon which may be explained by membrane polarization.


Elimination of cardiac glycosides through hemofiltration. Elimination of three different cardiac glycosides by hemofiltration was investigated using the flat bed RP-6 (Rhône-Poulenc, Paris). At a filtration rate of 59 +/- 9 ml/min the mean clearance of 3-H-g-strophanthin was 54.9 +/- 10.4, that of a 3-H-digoxin and unlabelled digoxin 36.7 +/- 6.6 and that of digitoxin 4.6 +/- 2.8 ml/min. It is concluded from these results that hemofiltration is able to eliminate more than 50% of the amount excreted during the same period of time by normal kidneys. Elimination of cardiac glycosides by continuous hemofiltration is high enough to justify its use in digitalis intoxication, particularly because of the excellent control of electrolyte balance with this new method of detoxification.


Amino acid loss during hemofiltration.

Amino acid loss during hemofiltration. Loss of free amino acids during hemodiafiltration therapy was investigated in 5 dogs. Hemodiafiltration was performed with a cellulose-acetate membrane with a limit of molecular separation at MW 19,000. The concentration of amino acids was investigated in ultrafiltrate and in blood at the beginning and at the end of diafiltration. Loss of amino acids in the ultrafiltrate was seven times as much as free amino acid content of plasma, whereas amino acid concentration in plasma decreased only slightly (20%). Applying these results to hemodiafiltration in man, it is concluded that loss of amino acids in hemodiafiltration is not greater than in conventional hemodialysis therapy.


Behavior of leucocytes and colony-forming units (CFU-C) in blood of chronic uremic patients during hemodialysis and hemodiafiltration. In a comparison of the effects of hemodialysis and diafiltration, we found that the transient decrease of circulating granulocytes seen in hemodialysis did not occur during diafiltration. We assume that this is the consequence of effective removal of a humoral leucotoxin by hemofiltration. The CFU-C changes observed parallelled the alterations in the granulocyte count both in hemodialysis and in hemodiafiltration.


Capillary membranes for hemofiltration.

Capillary membranes for hemofiltration. Membranes for hemofiltration were manufactured from blood-compatible polyamides in the form of capillaries. Hemofiltration units containing these capillaries were tested in vitro with aqueous solutions of salts and metabolites and with whole human blood. The results show that the capillary membranes fulfill the requirements for a membrane suitable for hemofiltration.


Asymmetric polyamide hollow-fiber filters in the hemofiltration system. We tested the asymmetric polyamide hollow fiber as the filter in the hemofiltration unit. Effective membrane thickness was 1mu, the diameter of the hollow fiber was 600mu, and the total surface was 1 m2. Membrane cutoff was determined at 13,000 daltons molecular weight. A fully automated system was used to replace the volume of ultrafiltrate with a balanced electrolyte solution. Clearance rates for BUN, creatinine, uric acid, and inorganic phosphate were calculated at 70-75 ml/min when prediluting (i.e., when balanced electrolyte solution is admitted to the arterial line of the extracorporeal circuit). Clearance rate for inulin was determined at 23 ml/min. Sieving coefficients for small molecular weight solutes were determined at 1.0 and for inulin 0.4. This decrease is explained by the development of a secondary protein layer and by unflavorable streaming conditions inside the hollow fiber. The ultrafiltrate remained free of protein.


Arteriovenous fistula as a complication of percutaneous femoral vein catheterization for hemodialysis. Sudden onset of congestive heart failure due to development of a femoral arteriovenous fistula in a hemodialysis patient is reported as a complication of repeated femoral vein catheterization for access. Closure of the fistula led to disappearance of signs and symptoms of congestive heart failure.