Monocular central-field occlusion for intractable diplopia. This report describes several methods of degrading imagery through the central portion of a spectacle lens to provide a cosmetically acceptable means of obtaining single vision in the central field of patients with intractable diplopia. For 2 strabismic patients with annoying diplopia, we applied to 1 spectacle lens a centrally placed disc (about 1 inch diameter) consisting of (1) translucent tap,a (2) a +7 D Fresnel lens,b or (3) stippled, clear lacquer. For 1 patient, the lacquer was the most acceptable; for the other, the tape was best. We present here the case reports for these 2 patients, showing why they preferred different image-degrading methods and how these and other methods of central-field image degrading can be advantageous even when diplopia is present across most of the visual field.


A study of vision in cerebral palsy.

A study of vision in cerebral palsy. One hundred twenty-eight patients (most less than 13 years old) with various types of cerebral palsy were examined to assess visual acuity, refractive state, oculomotor functions, sensory fusion, and ocular health. Special procedures for examining these patients are described. Vision or ocular defects were found to be present in 86% of these cerebral palsy patients. Significant refractive errors and strabismus were the most common defects, being present in 50% or more of the patients. Ocular disease was relatively uncommon.


The successful professional woman: on being married to one. Feminity and professionalism traditionally have been regarded as incompatible. From their own experience and that of colleagues and patients, the authors argue that female personhood is enriched by professional committment. In consequence, the woman with a career becomes a more stimulating spouse and parent. Problems of role differentiation and of time allocation stress the dual-career marriage, but coping with those stresses enhances personal growth and leads to a more rewarding marital relationship. The authors consider themselves the most fortunate of men.


Asylums revisited.

Asylums revisited. The authors revisited Erving Goffman's Asylum (Saint Elizabeths Hospital) and found both the "institutionalization" and "secondary adjustment" phenomena he described 20 years ago. However, they question whether secondary adjustments necessarily follows institutionalization. They also express doubt that institutionalization should be condemned automatically and suggest that it may in fact be the approach of choice for some patients.


Outpatient treatment of schizophrenia.

Outpatient treatment of schizophrenia. The authors discuss the treatment of 575 schizophrenic patients over the past 15 years. They describe a shift the patients have experiences from reliance on inpatient treatment to heavy use of outpatient services. The have found that effective outpatient treatment for these patients involves a program of nearly continuous administration of neuroleptic medication combined with counseling and social and crisis services. A major component of the outpatient management of these schizophrenic patients is the education of the patients in how to regulate their own medication within a prescribed range. This educational component appears to add a measure of precision that enhances the safety and reliability of the treatment program.


The medical basis of psychiatry.

The medical basis of psychiatry. The authors state that the medical model represents the most useful and appropriate model available for the practice of psychiatry. They discuss the implications for psychiatry of the three essential features of the medical model: the concept of disease and diagnosis, the concept of etiology and treatment, and the nature of the doctor-patient relationship. They conclude that the adoption of the medical model for psychiatry would have profound implications for residency training, continuing education, delivery of care, standards of ethical and professional practice, dealings with third-party payers, and conflicts with other professions.


A comparison of videotaped and live patient interview examinations and written examination in psychiatry. The authors scored the examination performance of 28 psychiatrists who were tested after conducting an interview with a real patient and after seeing a videotaped interview with an actor playing the role of either a psychotic or a neurotic patient. The also scored the performance of 15 of the same examinees who completed a written examination. Eighty-five percent of the examinees reported that the videotaped interview examination was a useful learning experience, and 81% said that it was a useful testing experience. The examiners' feelings varied regarding the use of the standardized videotaped format for certification and recertification of psychiatrists.


Platelet MAO activity in schizophrenia and other psychiatric illnesses. Previous reports have indicated that platelet MAO activity is low in some schizophrenic and other psychiatric patients. However, other studies have not been able to replicate this phenomenon. This study supportsthe previous observations of low enzyme activity in some chronic schizophrenic patients. The authors discuss the thesis that low platelet MAO activity may be a biochemical marker for vulnerability to psychiatric illness.


A psychodynamically oriented group training program for early childhood care givers. A training program for enhancing the care-giving qualities of child-care workers was developed and implemented through semistructured groups for family day-care mothers. The authors describe the theoretical orientation, program goals, and the outcome for trainees and trainers. Most impressive was the group process and content, which indicated the effectiveness of psychodynamically oriented program for care givers--people who ordinarly would not be expected to integrate such an experience successfully.


Episodic dyscontrol and family dynamics. The author describes characteristics of patients, primarily adolescents, who suffer from episodic violent behavior and their relations with their families. Typical family patterns include overly close alliances by the adolescent with one or both parents and transmission by parents of inconsistent values regarding aggression. Family therapy is the preferred treatment approach; treatment should be active, should initially focus on ways of handling dyscontrol episodes, and should emphasize that the patient is responsible for his or her actions.


Plasma testosterone in homosexual and heterosexual women. The authors measured plasma testosterone levels in 21 homosexual women and 19 age-matched heterosexual women. Although values for the two groups overlapped considerably, testosterone concentrations averaged 38% higher in homosexual than in heterosexual subjects. A statistically significant inverse correlation between age and testosterone level was found for heterosexual but not for homosexual women.


A study of 100 physician psychiatric inpatients. The author reviewed the case records of 100 physician inpatients in a private psychiatric hospital. He found that these physicians were more likely to have diagnoses of affective disorder and drug abuse than the general psychiatric hospital population, that their peak susceptibility occurred in their late 40s, that general practitioners and psychiatrists were overrepresented, and that female physicians were almost four times more vulnerable to suicide than male physicians. He describes some critical aspects of engaging the disabled physician in psychiatric hospitalization.


Focused psychiatric curriculum selection: student, psychiatrist, and nonpsychiatrist physician expectations. The authors obtained curriculum needs analysis data from second-year medical students and compared these with data obtained from nonpsychiatrist physicians and psychiatrists. All groups felt that interviewing skills, the doctor-patient relationship, managing the dying patient, and evaluation of suicidal patients were important topics. All gave psychological testing, behavior modification, mental retardation, and psychoanalytic theory the lowest teaching priority. The students gave a higher rating to all topics than did the other groups. The authors suggest that this kind of analysis can facilitate curriculum selection and implementation.


Juvenile court versus child guidance referral: psychosocial and parental factors. The authors compared the psychiatric symptoms, socioeconomic status, family structure, family size, and occurrence of treated parental mental illness in 136 children referred to a juvenile court and 82 children referred to a child guidance clinic. The prevalence of psychiatric and organic symptoms and treated parental psychopathology in both groups of children did not differ significantly. Juvenile court clinic children, however, tended to come from larger families and to lack a biological mother in the home. The authors explore explanations for the routing of sick children to the juvenile court rather than to a treatment facility.


Fear of the mentally ill: empirical support for the common man's response. The authors studied the hospital records of 400 hospitalized mentally ill patients for evidence of violent behavior leading to admission. They found that 36% of 321 admissions (excluding patients diagnosed as having a personality disorder or as drug-and/or alcohol-dependent) were preceded by some form of violent, fear-inspiring behavior. They suggest that mental health professionals deal with the general public's fear of the mentally ill on the basis of such findings rather than dismiss it as illogical.


Briquet's syndrome, hysterical personality, and the MMPI. The authors compared the MMPI scores of 29 inpatients diagnosed by other authors as having hysterical personality and 21 outpatients diagnosed by the authors as having Briquet's syndrome. The two groups of patients differed significantly in age, on the MMPI lie scale, and on the MMPI hypochondriasis scale but not on any of the other MMPI scales. The authors discuss the implications of these findings for further defining the differences and similarities between hysterical personality and Briquet's syndrome.


Psychiatric observations of state and local politicians. The author, a psychiatrist and an elected official in a small town, compares his observations of local politicians with a mental health commissioner's observations of politicians at the state level. The author feels that local politicians tend to be more strongly oriented toward relatively altruistic public service. Several factors, including personal ambition and reduced public scrutiny, may contribute to the apparently greater selfishness of politicians at the state level.


ECT and ethical psychiatry.

ECT and ethical psychiatry. The author discusses the right to receive ECT and describes voluntary and involuntary patients for whom the treatment seemed both ethical and humane. The right to refuse ECT must be respected in competent patients. However, problems arise when patients' decision-making ability is compromised by their illness. Informed consent questions include how much and what type of information patients should receive and how much those with disordered cognitive functioning can be expected to understand. The author believes that ECT should be fully voluntary whenever possible and that a court-appointed guardian should make such treatment decisions for incompetent patients.


Shock treatment, brain damage, and memory loss: a neurological perspective. The author reviews reports of neuropathology resulting from electroconvulsive therapy in experimental animals and humans. Although findings of petechial hemorrhage, gliosis, and neuronal loss were well established in the decade following the introduction of ECT, they have been generally ignored since then. ECT produces characteristic EEG changes and severe retrograde amnesia, as well as other more subtle effects on memory and learning. The author concludes that ECT results in brain disease and questions whether doctors should offer brain damage to their patients.


Coexisting childhood schizophrenia and myasthenia gravis treated successfully with neostigmine bromide. A 12-year-old boy who had suffered from severe schizophrenia for 8 years developed myasthenia gravis. Both disorders were treated simultaneously and successfully with neostigmine bromide. The authors suggest that these two disorders may in some cases be part of the same disease process and urge that physicians consider this possibility in patients with severe emotional problems and muscle weakness.


Accountability, public policy, and psychiatry. The author identifies the direction of changes in health policy in the United States that need to be taken into account by the health professions in their dealings with government. She discusses three areas in which these changes will call for adjustment on the part of the medical profession and major health care institutions and defines the special challenge to psychiatry implicit in the changes. She concludes that the public's need for attention to the psychosocial aspects of health and the renewed interest in prevention present psychiatry with an opportunity to provide leadership in health care delivery.


Diagnosis: schizophrenia versus posterior aphasia. Schizophrenia and posterior aphasia are easily cross-diagnosed, primarily because of similarities in verbal output, i.e., vagueness, looseness of association, and apparent confusion. Tape-recorded interviews with 8 posterior aphasics and 10 "loose" schizophrenics were transcribed and analyzed to provide guidelines for the clinician to differentiate the two conditions by monitoring verbal expression. Six major differentiating characteristics were identified. The authors present hypotheses that emphasize differing neuroanatomical loci and neuropsychological mechanisms to explain the differences in verbal output in schizophrenia and posterior aphasia.


A study of treatment needs following sex therapy. The authors describe 19 couples who returned for additional treatment after traditional short-term sex therapy. Eight couples required additional short-term sex therapy, and 11 couples were treated primarily with individual psychoanalytic psychotherapy or conjoint therapy for an extended period of time. The authors identify three reasons for return to therapy: 1) treatment overload, 2) severity of symptoms, and 3) presence of psychopathology relevant to the sexual dysfunction. They point out that pleasure, intimacy, and cooperation dysfunctions need to be worked through if sex therapy is to have lasting effects.


On the course of anorexia nervosa.

On the course of anorexia nervosa. The authors trace three phases in the course of anorexia nervosa and compare its physical and psychological symptoms with those of starvation. Phase I, which may occur months or years before the illness, usually includes precipitating events that result in loss of self-esteem and increased self-consciousness about physical appearance. During phase II patients develop the "anorectic attitude," an unreasonable fear of eating, and show pride in their ability to lose weight. By phase III patients are forced by the severity of starvation symptoms to admit that they are ill. Although many of the physical symptoms of starvation and anorexia nervosa are similar, anorectic patients, in contrast to victims of starvation, show high initiative, the ability to suppress hunger, restless hyperactivity, and body image distortion.


Teaching psychological medicine to family practice residents. The authors describe the development of a curriculum focused on teaching residents in family practice how to recognize and deal with the psychological issues presented by patients and by their own reactions to patients. They describe how teachers in a medical school's divisions of family practice and psychosomatic and liaison psychiatry collaborated to develop an integrated training program and the changes this program effected in the attitudes and understanding of residents. They found that residents in this program shifted their emphasis from a narrow view of traditional medical diagnosis and treatment to a broader psycholgical-biological understanding of patients.


Myths of "shock therapy".

Myths of "shock therapy". The author discusses the myths of the ECT process--that shock and the convulsion are essential, memory loss and brain damage are inescapable, and little is known of the process--and assesses the fallacies in these ideas. Present views of the ECT process suggest that its mode of action in depression may best be described as a prolonged form of diencephalic stimulation, particularly useful to affect the hypothalamic dysfunctions that characterize depressive illness. The author emphasizes the need for further study of this treatment modality and for self-regulation by the profession.


Therapeutic technique: treatment of a borderline adolescent girl. This paper is a case presentation of an acting-out borderline adolescent girl, who had been exposed to three previous attempts at treatment. The clinical material gives evidence of diagnostic and dynamic understanding of the borderline syndrome. The treatment technique--confrontation--is elucidated with examples of its use.


Teaching psychotherapy by use of brief typescripts. A typescript of a 10-minute segment of a taped therapeutic interview, coded by using a modification of the Gottshalk scales, quite clearly demonstrates the patient's current focal conflict. Recognition of the current focal conflict is thus taught, and this is used as an organizing principle in supervision of psychotherapy.


Special problems of women in psychotherapy. Feminist critics have failed to acknowledge the usefulness of Freud's neutral observations about female sexual development. This paper is an attempt to refute the prejudiced, incorrect view of the modern psychoanalytically oriented psychotherapist as sexist in orientation. Several detailed case examples are utilized to illustrate the interpretive treatment of excessive passivity in women patients with a variety of neurotic difficulties.


Family sequelae after a child's death due to cancer. In a small study assessing the psychologic sequelae on disadvantaged families after a child's death from cancer, a high incidence of psychologic problems was found. The implication is that the coping mechanisms failed partially as a result of inadequate anticipatory griefing.


Play, fantasy, and symbols: drama with emotionally disturbed children. This paper discusses the developmental continuum of play and its relationship to drama. The functions of drama therapy as a form of child psychotherapy are illustrated through case material, focusing on wish fulfillment, psychic integration, reenactment of past traumatic experiences, transformation from passivity to activity, separation of fantasy and reality, fusion with the idealized or hated parent, defense and mastery. The value of drama therapy is not only in the abreaction it provides, but in the chance to articulate the fantasies through play, experience the working through of the conflicts, and connect the past to the present.


Ideological conflicts between clients and psychotherapists. Clients come to psychotherapy with their own theories of how their problems are to be solved. These ideas fall into five categories: relationship rescue, will power, vindication, bromide, and spiritualistic theories. Many of the classic disputes which arise between clients and therapists can be attributed to differences in their theories of cure.


A multimodality approach to inpatient treatment of obsessive-compulsive disorder. A case of severely incapacitating obsessive-compulsive neurosis is treated in an inpatient setting for 13 weeks with a combination of insight-oriented, group, family, and behavioral therapies. The synergistic effects of these modalities and the therapeutic community are discussed. Stable changes are evident 2 1/2 years after admission.


Maternal mortality in Michigan: an epidemiologic analysis, 1950-1971. An analysis was performed of direct maternal mortality over 22 years (1950 through 1971) in the state of Michigan. The overall direct maternal mortality rate fell from 5.0/10,000 live births in 1950 to 1.5 in 1971. The rate among nonwhites was more than four times greater than among whites and the difference in relative risk did not narrow over the 22 years. Mortality rates increased with increasing maternal age but not with increasing parity. Nulliparous women had a significantly higher mortality rate than did parous women, particularly those over 25 years of age. when the white gravida of urban Wayne County were compared with the white gravida of 33 rural counties, no difference in direct maternal mortality rates could be attributed to rurality per se. Hemorrhage, infection, and toxemia were the leading causes of direct maternal death. The data suggest that hospitals with less active obstetrical services were associated with a higher risk of direct maternal mortality than were hospitals whose obstetrical services were more active. An increasing proportion of the direct maternal deaths was designated as preventable over the study period. It is believed that analyses of maternal mortality have led to improved perinatal and obstetrical care and that further advances require their continued support. (Am. J. Public Health 67:821-829, 1977)


The impact of state maternal mortality study committees on maternal deaths in the United States. State maternal mortality study committees have been widely credited with playing a prominent role in reducing maternal death rates in the United States. To evaluate this hypothesis, we compared the rates of decline in maternal mortality ratios by decades from 1938-40 to 1968-70 for states with such committees to those without. Ratios were calculated from published vital statistics of the United States, and committee initiation dates were obtained from a previous survey. States with committees and those without had nearly equal declines during the first decade; however, states with committees had smaller declines during the latter two decades. Although these committees may have been an important factor in the decline in maternal mortality in the United States, vital statistics data do not document larger declines for states with committees.


Age-adjusted mortality indexes for small areas: applications to health planning. This study compares four age-adjusted mortality indexes and their standard errors among United States counties using 1969-1971 mortality data. It is shown that the direct and indirect methods of age adjustment give nearly identical results (correlation coefficients over .97). Two other indexes which indirectly adjust for age are then compared with the usual indirect method: one is the relative mortality index and the other an index of productive years of life lost. The three indirect indexes are substantially different in the are groups emphasized. This results in substantial differences in those counties identified as having "excess" mortality. Implications of the results for health planning applications are discussed.


Hemoglobin levels in children from a biracial southern community. Hemoglobin levels were determined for 4,081 children, ages 2 1/2-14 years, from a biracial southern community. Back children had lower levels of hemoglobin than white children at every age interval with a mean difference of 0.64 gm/dl. This diffence persisted even when comparing children from similar socioeconomic level households. If black children maintain lower hemoglobin levels consistent with optimum health than do white children, then different hemoglobin standards may be warranted for each race.


Consumer nutrition knowledge and self reported food shopping behavior. In 1975 a national sample of consumers was questioned about their knowledge of nutrition, beliefs about food, and their shopping behavior. Findings indicate a particular need for education related to facts about iron, thiamin, riboflavin, and vitamins A and D. Consumers with low knowledge tended to have less education, lower income, and less prestigious occupations. Of these variables, educational achievement level had the strongest association to low nutrition knowledge. Using an index based on the three socioeconomic variables, low knowledge was more often present among the male and older shoppers, with age having the stronger association. Association of the three indices of nutrition knowledge, food beliefs, and reported shopping behavior were found to be positive and linear.


Environmental health and safety in the academic setting. The academic institution can be viewed as a community within a community, with many environmental concerns similar to those of a municipality: private water supplies, housing, food sanitation, injury control, occupational health, radiation protection, waste control, etc. The complexity of a university environmental health and safety (EHS) program is closely related to the size of the college or university, and the type of program carried on by the institution (e.g., teaching hospital, agrigultural experiment stations, amount and variety of research programs). This paper seeks to convey information about environmental health and safety programs in colleges and universities which will be of help to environmental regulatory agencies as they interact with academic institutions. Understanding internal organizations and policy matters will make environmental regulatory agencies more effective as they interact with academic institutions. The extent of regulatory change now impacting on academic institutions is also discussed.


Duodenoscopy and endoscopic pancreatography in patients with postive morphine prostigmine tests. Twenty-three patients with abdominal pain and positive morphine prostigmine tests underwent duodenoscopy and endoscopic retrograde cholangiopancreatography (ERCP). Sixteen demonstrated marked or moderate ampullary stenosis. The pancreatic duct was dilated in three and stenotic in four. Ampullary stenosis was confirmed in all patients who subsequently underwent sphincteroplasty. Only six patients had pancreatitis demonstrated by appropriate laboratory studies or at surgery. Relief of pain after sphincteroplasty was complete in ten patients during follow-up.


Primary adenocarcinoma of the small intestine. Eighteen cases of primary adenocarcinoma of the small intestine have been reviewed, which demonstrated the relative frequency of symptoms common to this disease. The clinical features, pathology, and treatment of small bowel adenocarcinoma have been presented and the literature reviewed.


Electrical, contractile, and radiographic studies of the stomach after proximal gastric vagotomy. The effects of proximal gastric vagotomy on the gastric electrical and contractile activities and on gastric emptying of solid food were studied in dogs. Proximal gastric vagotomy produced only minimal alteration of the electrical activity and did not significantly alter the response of the electrical and contractile activities to vagal stimulation (insulin) and local stimulation (food). Barium meal studies showed no delay in gastric emptying time after proximal gastric vagotomy but significant delay after truncal vagotomy. The findings support the clinical impression that gastric motility and empyting (solid) remain relatively normal after proximal gastric vagotomy.


Corrosive gastritis.

Corrosive gastritis. Cases of corrosive gastritis are relatively few in the literature. Fifteen patients with combined corrosive esophagogastritis are reported on herein. In the acute stage (with severe degree of esophagogastritis) feeding jejunostomy was recommended, whereas in the chronic stage (with gastric obstruction) posterior gastrojejunostomy was performed for all patients. Patients were classified into three grades depending on the extent of associated esophagitis. We conclude that corrosive gastritis is a possible associated complication of corrosive intake (particularly for suicide) and requires a latent period of time to be clinically evident.


Congenital cystic dilatation of the common bile duct as a cause of primary bile duct stone. Of the 101 patients with congenital cystic dilatation of the common bile duct, eighty-eight with adult-type cysts are reported on. The association of primary bile duct stone and adult-type cyst of this anomaly is discussed and found to be higher than previously recognized. In the cases without calculi, abnormal arrangement of the pancreaticobiliary ductal system is indicated to play an important role in the manifestation of the symptom. The anatomic and clinical features and the results of treatment for this type of cyst are reviewed.


Periappendicitis: Clinical reality or pathologic curiosity? The data from a retrospective study of 224 patients with preoperative diagnosis of acute appendicitis are presented. Periappendicitis was subsequently diagnosed in 5.4 per cent of these patients. More than half of these patients with periappendicitis had other intraabdominal disease demonstrable at operation. The remaining patientw with periappendicitis were followed for two years, and long-term complications were not observed. It is concluded that periappendicitis does not represent an unrecognized nonappendiceal process that requires special management.


Incidence of hypoparathyroidism after radical surgery for thyroid carcinoma and autotransplantation of parathyroid glands. Ninety-seven consecutive patients had radical surgery for thyroid carcinoma. Eighty-six of these had one or more parathyroids implanted into muscle tissue. At follow-up, ninety-one patients were normocalcemic without substitution, fifteen of those with only implanted glands. The results show that radical surgery can be performed with a low incidence of hypoparathyroidism, provided the parathyroids are carefully searched for and liberally implanted.


Ultrasonic and fluorescent scanning: A combined noninvasive diagnostic approach to extrathyroidal neck lesions. Thirteen patients with suspected extrathyroidal neck masses were investigated with the combination of fluorescent scanning and echography. Iodine content, the solid or cystic consistency of the lesion, and the position of the lesion with respect to the thyroid were determined preoperatively to estimate thyroidal origin and benignity or malignancy of the lesions. Pathologic diagnoses correlated well with these totally noninvasive studies of extrathyroidal neck masses.


Nosocomial infection rates at a General Army Hospital. An eighteen month study of the incidence of nosocomial infections was conducted at a 436 bed general army hospital. The overall rate of nosocomial infection was 1.48 per cent, with a monthly range of 0.42 to 2.30 per cent. Gynecology had the highest rate of 5.8 per cent. Escherichia coli, klebsiella, and Staphylococcus aureus were the major hospital pathogens. No emergence of unusual drug resistance was observed during the course of the study. Further studies should be conducted to establish guidelines of surveillance for nurse-epidemiologists in this type of hospital.


The significance of aortoiliac atherosclerosis as assessed by Doppler ultrasound. A simple, noninvasive method of assessing atherosclerotic aortoiliac obstruction is described using Doppler ultrasound with a concurrent electrocardiogram. The method is significantly more accurate than clinical examination. The pulse wave velocity profile at the common femoral artery is recorded with a nondirectional Doppler probe. The time delay from the R wave of the concurrent electrocardiogram to the ultrasound waveform peak and to a point half-way up the waveform upslope is measured. By evaluating the mean of ten such measurements at each point and then by taking the ratio of the former to the latter, a Proximal Damping Quotient (PDQ) may be derived. If the PDQ is greater than 1.4, significant proximal obstruction is probable. Conversely, a PDQ of less than 1.4 suggests a functionally clear aortoiliac segment. Any patient with a PDQ of less than 1.3 in whom reconstructive surgery is being correlated may thus be spared an aortogram and the affected limb may be investigated by femoral angiography alone. A low PDQ is supporting evidence of an adequate "run-in" to the distal segment when a distal arterial reconstruction is proposed. Similarly, if a femoro-femoral crossover graft is to be used, then significant aortoiliac atherosclerosis proximal to the donor femoral artery may be excluded without recourse to aortography.


A clinicopathologic review of benign giant cell tumors of tendon sheaths in Ibadan, Nigeria. Thirty-four patients (19 female, 15 male) with benign giant cell tumors of tendon sheaths were studied from the University College Hospital, Ibadan, Nigeria. Ages ranged from eleven to sixty years. The main presenting symptoms were swelling in ten patients and pain in five. Twelve patients gave history of trauma. Only three patients had bony erosion. Gross pathologic and histologic features of the giant cell tumors of the sheath are discussed. Two illustrative cases show the characteristic behavior of the lesion.


Volvulus of the transverse colon.

Volvulus of the transverse colon. Five cases of volvulus of the transverse colon are presented. Two distinct clinical types are noted and discussed, each with a significantly different mortality. The level of volvulus dictates the limitations of diagnostic aides and appropriate treatment.


Jejunal loop interposition in patients with ileal conduit failure after pelvic exenteration. Although the ileal conduit is currently the most widely used method for urinary diversion in patients undergoing pelvic exenteration, reports continue to accumulate indicating the frequency of long-term complications. Four patients with failure of ileal urinary diversion after pelvic exenteration for invasive pelvic malignancy are presented. All four patients had either multiple pelvic surgical procedures and/or pelvic radiation. Interposition of jejunum between the proximal ureters or renal pelvises and skin was performed with satisfactory results in all four. In patients with pelvic exenteration and failure of ileal urinary diversion this technic offers the following advantages over the conventional revision of the ileal conduit: (1) eliminates use of radiated small intestine which is subject to fistula formation and/or obstruction; (2) avoids the settling of the urinary conduit in the devitalized pelvic space with potential adhesions, fistula formation, or obstruction; (3) ensures proximal jejunal loop is away from area of potential tumor recurrence and field or previous or future radiotherapy; (4) eliminates the extensive dissection of the adherent ileal conduit and subsequent risk of avascular necrosis; and (5) bypasses the radiated fibrotic distal ureters.


Spontaneous hemorrhage due to pseudocysts of the pancreas. Spontaneous hemorrhage caused by erosion of major arteries by a pseudocyst of the pancreas is a rare condition. We have encountered three cases, one involving the abdominal aorta and two the superior pancreaticoduodenal artery. It is important to keep in mind that pseudocyst of the pancreas may cause massive gastrointestinal or intraabdominal bleeding. Operative treatment offers a better chance of survival than more conservative management.


Nonsurgical pneumoperitoneum.

Nonsurgical pneumoperitoneum. Free intraperitoneal air is not necessarily caused by a perforated viscus. The present study reviews the causes of pneumoperitoneum that do not necessitate laparotomy, and emphasizes the importance of obtaining a complete clinical history.


Penetrating injuries of the appendix.

Penetrating injuries of the appendix. Although rare, penetrating injuries of the appendix pose an interesting finding at laparotomy. Associated penetrating gastrointestinal injuries are common. Four additional cases of trauma to the appendix from penetrating wounds are described.


Subclavian placement of flow-directed thermodilution catheters. A rapid and safe technic. A rapid and safe method for the placement of No 7 French flow-directed thermodilution catheters via an infraclavicular subclavian approach is described.


Unhealed perineal wound: lavage with a pulsating water jet. The use of the pulsating water jet lavage (Water Pik) in the care of the perineal wound is discussed. The relative case with which debridement of a difficult-to-locate perineal wound can be efficiently debrided and cared for by a patient on an ambulatory basis is stressed. This facilitates early patient hospital discharge and offers effective self-care to the patient.


Coarctation of the aorta and severe aortic insufficiency: What to repair first? A new surgical approach is proposed for patients with coarctation of the aorta associated with severe aortic valvular insufficiency. The valvular lesion should be repaired first and the coarctation corrected during a second operation; both interventions should be done during the same hospital stay. We base our approach on the belief that improved coronary perfusion can be achieved when the aortic insufficiency is corrected first. The disadvantages of the opposite surgical approach, such as anticoagulation problems, renal underperfusion, and hypertensive complications are easily avoided.


A simple technic for inserting a Scribner shunt in a stenotic artery. A simple technic of limited segmental endarterectomy is described, which will often make possible the insertion of a Scribner shunt in a highly stenotic artery for temporary dialysis.


Stimulus deprivation in windowless rooms. Enough evidence now exists to suggest that windowless environments in hospitals increase the risk to the patient for a number of reasons. These include a direct influence on his own physiological and psychological state, a lowering of the standard of care by an effect on hospital staff, and increased vulnerability to physical hazards. The psychological ill effects of the intensive therapy unit (ITU) environment on its occupants are well recognised. The aggravation of these effects by the construction of any further windowless units can no longer be regarded as acceptable.


Tracheal damage associated with cuffed tracheostomy tubes. Aspiration of gastric content as a cause of local damage in tracheotomised dogs. Dogs were subjected to  tracheostomy and intubation with low pressure cuffed tracheostomy tubes. Various mixtures of bile, gastric secretion and 0-1 N Hydrochloric acid were injected into the trachea via a small catheter attached to the main tracheostomy cannula to simulate the effect of aspirated gastric contents. Bronchoscopic observations were made during the study to investigate the local effects of secretions pooling above the cuff, in contact with the tracheal wall. Gross pathological changes were observed when the animals were sacrificed at the end of the study. The constituents of a mixture of bile and gastric juice increased the severity of tracheal damage due to mechanical trauma and sepsis. Healing was delayed and the reparative process was abnormal. This experimental study indicates that the combination of bile and acid pepsin reaching the tracheal wall may also be a major factor which predisposes to the development of early and late tracheal injury.


Etomidate in urological outpatient anaesthesia. A clinical evaluation. Induction of anaesthesia with the new short acting agent etomidate has been studied in 200 patients undergoing urological outpatient procedures. These patients exhibited a similar pattern of recovery to those receiving 7 mg/kg propanidid but had greater cardiac and respiratory stability. However, there was a 25% incidence of pain which was reduced to 13-9% by increasing the rate of injection from 30 to 15 seconds. The incidence of involuntary movements was 29-7% which was reduced to 15% by the faster rate of injection. The omission of atropine premedication did not affect cardiac stability. Etomidate appears to have many desirable features as an induction agent except for a high incidence of pain on injection which is reduced by rapid injection.


The Eighteenth John Snow Memorial Lecture. The anaesthetist and the law. The nature of the possible litigation, in which anaesthetists may be involved and the nature and manner of the preparation, which are necessary if he should be required to appear in court, are discussed.


Labour retarded with beta-agonist drugs. A therapeutic problem in emergency anaesthesia. A case of prolapsed umbilical cord is recorded in which an overdose of orciprenaline was given to the mother. The physiological and pharmacological implications to the mother and fetus are discussed and a method of treatment is suggested.


Intramuscular ketamine with hyaluronidase. Nineteen daily anaesthetics administered to a child for radiotherapy. Intra-muscular ketamine with hyaluronidase was used on nineteen occasions to provide anaesthesia for daily radiotherapy in a 22-month-old boy with a rhabdomysarcoma of the bladder. The technique produced a sharper, reliable recovery and allowed the child his normal fluid and caloric intake within 90 minutes.


Muscle fibrillation following thiopentone and pancuronium bromide. An association with metachromatic leucodystrophy. A case is reported of muscle 'gibrillation' following the administration of thiopentone and pancuronium to a patient suffering from metachromic leucodystrophy and possible mechanisms are discussed.


Physical distress suffered by terminal cancer patients in hospital. The incidence severity, and degree of relief obtained from treatment has been estimated and evaluated in 117 patients suffering from terminal cancer.


Letter from Nepal. Rag and bottle updated. Anaesthesia as it is practised in a small urban hospital in Nepal has been described. The people of Nepal have great surgical needs, and good, simple, anaesthesia is vital. Surgery is demanding on time and space; is it as vital as an 'under-fives clinic' or a preventative medicine programme? As the staff of the Shining Hospital decreases and as the Government Hospital takes over more acute surgery, I do not think so, and thus I am, temporarily, happy to be involved in the control and treatment of tuberculosis.


Drug treatment of malignant hyperpyrexia. Of the various drugs currently suggested for the treatment of malignant hyperpyrexia, dantrolene sodium was the most effective in reversing and inhibiting drug induced contractures in vitro, both in normal muscle and in muscle from patients who are susceptible to malignant hyperpyrexia. It is suggested that dantrolene sodium is the drug of choice for lowering the raised myoplasmic calcium concentrations in malignant hyperpyrexia.


Methohexitone-induced convulsions in epileptics. The risk of precipitating a convulsion in epileptic patients with methohexitone has been judged to vary widely. This article reports such complications arising during methohexitone-activated E.E.G. recording in a series of 48 epileptic patients from whom anticonvulsant medication was withheld. Two patients developed grand mal convulsions during induction with methohexitone 1-0%. Two others exhibited status epilepticus of the petit mal type and one of the myoclonic type, after stopping an infusion of 0-09% methohexitone. The specificity for methohexitone-induced convulsions in epileptics or crypto-epileptics is supported by a review of the literature.


Thermographic assessment of peripheral arterial occlusion. Infra-red thermography was used to confirm the observation that the temperature differences between corresponding areas of skin on opposing hands are normally minimal and to demonstrate that the skin temperature of the hand distal to an occluded radial or brachial artery was lower than that of the contra-lateral hand. Temperature differences between the two hands decreased with time and had disappeared by the time that recannulation of the occluded artery, gauged by the modified "Allen" test, had occurred. Thermography is a simple and noninvasive technique and provides a useful indicator of the incidence and progress of peripheral arterial occlusion such as that which may follow arterial cannulation.


Anaphylaxis to suxamethonium--a case report. A case history is presented of a woman who developed very severe bronchospasm, hypotension, "lobster-red" erythema and later angio edema of the head and neck after induction of anaesthesia for caesarean section. Intradermal testing at a later date, showed immediate-type sensitivity to suxamethonium.  Reference is made to the other few reactions to suxamethonium reported in the world literature.


Teaching anaesthetics in the operating theatre. During an anaesthetic procedure the anaesthetist's main concern is for the patient and his vigilance ensures that the patient is given the best care possible. When a trainee anaesthetist is administering an anaesthetic a tutor is often present to further improve the trainee's practical knowledge or technique. This report presents the results of an investigation of the typical patterns of trainee anaesthetist's behaviour when a tutor is either present or absent in order to establish whether the teaching which occurs in the operating theatre affects the pattern of activity and vigilance. Results indicate that the patterns of behaviour are unaffected by a tutor's presence, and that teaching anaesthetics in the operating theatre may be a legitimate activity which does not interfere with the trainee's prime function of patient care.


"Dextrostix: revisited.

"Dextrostix: revisited. A clinical trial compared blood glucose measurements obtained with reagent strips and the Eyetone Meter with those obtained on an AutoAnalyser. The blood glucose readings obtained with the Eyetone Meter were sufficiently accurate for clinical use in Intensive Care Medicine and Anaesthesia.


Prolonged apnoea due to suxamethonium in Chinese. A Chinese patient was hypersensitive to a therapeutic dose of suxamethonium because of a genetically determined quantitative and qualitative abnormality of plasma pseudocholinesterase.


A new laryngoscope.

A new laryngoscope. A new laryngoscope incorporation a mechanism operated from the handle which facilitates endotracheal intubation in situations where an introducing stylet would normally be required.


A laryngoscope for obstetrical use an obstetrical laryngoscope. Rapid tracheal intubation, using the standard Macintosh laryngoscope, can be hindered in obstetrical patients by the handle of the laryngoscope hitting the patient's engorged breasts and the hand of the assistant applying cricoid pressure. To overcome these difficulties a variation of the laryngoscope is described. The right angle of the blade to the handle is opened by a further 20 degrees.


A scavenging device for the T-piece.

A scavenging device for the T-piece. An inexpensive and convenient method of collecting waste gases from the open-tailed bag of a T-piece system is described.


[The cellular content of different structural components in the regional lymphe nodes of the man in different age groups (author's transl)]. It was observed that in man in the same ageing group is relatively constant the content of reticulum cells, middle and little lymphocytes in the cortex, primary and secundary follicles and medullar cords of the lymphe nodes. The age depended changes of the cell content in the lymphe node is visible in the increase of little and decrease of middle lymphocytes. The content of reticulum cells altered not during the life. The structural behaviour of the cell content is very important for the cellular immunity in man.


Ultrastructure of the epidermal cells of the teleost Pimelodus maculatus Lacépède, 1803 (pisces). By means of electronmicroscope technique were studied the cell types in the epidermis of the teleost Pimelodus maculatus LACEPEDE. The varied cells were described after their morphological aspect. The behaviour of the plasma membrane and the cytoplasmatic components, especially the microfilaments and the rough endoplasmatic reticulum, were discussed in the functionally manner of this cells. The relationship of the cell types to the mitotic cell cycle gave some interesting references.


Histopathological aberration in fish skeletal muscle during induced starvation. Effects of induced starvation on the histology of the fish skeletal muscle, have been studied in the "red muscle" of Heteropneustes fossilis. The tissue has been studied at weekly intervals, for four weeks. The intrafibrillar as well as the interfibrillar nuclei exhibit different behaviour in the red and the white muscle fibre types. Loss of myofibrils, predominantly in the white fibres, is accompanied with an increase in the non-contractile extrafibrillar tissue.


Morphology of the accessory reproductive glands of some male Indian chiropterans. The accessory glands of seven species of male chiropterans are described. The unpaired prostate and paired Cowper's glands occur in all the species. The seminal vesicles are present only in Cynopterus and Taphozous. The ampullary glands occur in all the species except Cynopterus sphinx. The presence of solid rounded bodies is a characteristic feature of the seminal vesicles of Cynopterus sphinx. The urethral gland is present in all the species except Taphozous and Rhinopoma; utriculus prostaticus was not seen in any of the species investigated. The study reveals that the male accessory glands show great diversity and remarkable differences are seen even between closely related species.


[About the face value of the cleft of the articulus mandibulae (author's transl)]. The planimetry of negative replicas on the mandibular joints from older men has shown very important relations between the squamal discoidal and mandibular faces. The results were demonstrated in a table.


Anatomical evidence of one-sided forelimb dominance in the rhesus monkey. 1. Differences in muscle and bone weight in the right and left forelimbs have been studied in twelve Rhesus monkeys. 2. There is anatomical evidence suggestive of one-sided limb dominance in nine animals, dominance being right sided in six animals and left sided in three animals. 3. The mean weights of all muscles and bones are greater on the dominant side except for the pectoralis major, the teres major and the clavicle. 4. The mean weight of the pectoralis major is greater on the non-dominant side and that of teres major and clavicle is equal on the two sides. The significance of these findings has been discussed in the light of observations in human adults and foetuses.


Neurohistochemical evidence supporting an absence of adrenergic and cholinergic innervation in the human placenta and umbilical cord. Neurohistochemical techniques were used to determine the distribution of adrenergic and cholinergic nerves in the human placenta and the umbilical cord adjacent to the chorion. These morphologic studies demonstrate the absence of neural elements in these sites. The significance of these findings to the placental innervation controversy is discussed.


Enzymatic isolation of osteoblasts from fetal rat calvaria. A microanatomical study of the immature rat calvarium was performed in order to develop a method for the isolation of osteoblasts by enzymatic means. Although generalized osteogenesis was evident in fetal rats, differential growth patterns were observed beginning at 19 days in utero. Considerable portions of the endocranial periosteal bone surface were lined by flattened, less active cells; discrete areas also contained multinucleated osteoclasts. Cell counts of whole calvaria revealed that one fifth of the total cell population were osteoblasts, most of which were located in the central portions of the frontal and parietal bones. Prior excision of these segments permitted the subsequent removal of virtually all periosteal tissues. Cleaned 19-day fetal bones, incubated in crude collagenase for two hours, released about 40,000 cells/calvarium, consisting of 85-90% osteoblasts and lesser amounts of connective tissue and bone marrow elements. Because of the relatively small sizes of most extraneous cells, purity on a cell volume basis was approximately 95%. It is predicted this preparation will be useful in the investigation of certain aspects of osteoblastic function.


The origin, migration and fine morphology of human primordial germ cells. Human primordial germ cells (PGCs) were observed ultrastructurally in stages from their endodermal to gonadal locations. Primitive PGCs in the hind-gut epithelium of the 4-week embryo, were recognized as well demarcated cells from the neighboring cells. At the time fo separation, the basal lamina of the epithelium was broken, then, through the gap so opened, the PGCs started to escape into the outer mesenchyme. In embryos at five weeks, PGCs were in the migration stage, and were found in the dorsal mesentery, at the coelomic angle and in the forming germinal ridge. In embryos at six weeks or later, almost all PGCS were accumulated in the gonad. The PGC was characterized by its large size and the large and round nucleus with conspicuous nucleolus, and by the presence of abundant glycogen particles and a considerable number of lipid droplets in the cytoplasm. Alkaline phosphatase activity was demonstrated selectively on the plasma membrane of the PGC. The shape of PGC was irregular, often had pseudopodia in PGCs in the separation and migration stages, suggesting their amoeboid movement in vivo, but was generally round or elliptic in PGCs in the settlement stage. The PGC was usually surrounded by and in close association with adjacent somatic cells.


Immunological and morphological effects of vasectomy in the rabbit. Half of the rabbits developed antisperm antibodies (measured by either indirect immunofluorescence or sperm immobilization tests) after either a unilateral or bilateral vasectomy. The raised antibody levels, particularly six months or longer after vasectomy, often accompanied patchy orchitis. Seminiferous tubules from such animals exhibited sloughed, multinucleated, and immature germinal cells which were engulfed by phagocytic cells. Mononuclear infiltrates were occasionally present. The basal lamina infolded and thickened by means of supernumerary layers and appeared to be endocytosed by cells of the seminiferous tubules. Four months after vasectomy, numerous phagocytic cells were seen in migrate through the intact epithelium of zone 1 in the caput epididymidis, and were particularly prevalent in animals that exhibited testicular damage. These macrophages may serve to present sperm antigens to lymphocytes.


Serous cysts of the aging guinea pig ovary. I. Light microscopy and origin. Ovaries from guinea pigs of different ages have been examined by light microscopy. Serous cysts measuring between 1 mm and 2.5 cm are present in all animals over one year of age. The cysts are fewer in number and size at six months, are least developed at ten weeks and are not apparent in the near-term fetus. The cysts arise from the rete ovarii. They are lined with a simple cuboidal to columnar epithelium composed of cells bearing solitary cilia or tufts of cilia. The structure and origin of these cysts is discussed and compared with what is known of the human serous cystadenoma.


The embryonic development of theproctodeal gland of Coturnix coturnix japonica (Aves). The embryogenesis of the proctodeal gland and development of the connective tissue of the associated lamina propria in the dorsal wall of the proctodeum of Common Coturnix (Coturnix c. japonica) were studied on embryos collected at 12-hour intervals from day 7 of incubation through hatching. Gland development began at 9.5 days from ectodermal-derived epithelial buds developing in the craniolateral region of the dorsal proctodeal epithelium. At 11 days, the epithelial buds had become solid convoluted epithelial cords which, by 11.5 days branced to form solid individual glandular units. Lumina of the unit were formed by degeneration and vacuolization of the central cells of these solid units. Squamous epithelial caps, several layers thick, separated the vacuolizing units from the proctodeal cavity at day 13; these caps subsequently thinned, bulged into the proctodeal cavity and, by day 16, began to disappear opening the lumen of the units to the proctodeal cavity. Sequential formation of epithelial buds, by region, was: craniolateral at 9.5 days, craniomedial expansion at 10.5 days followed, beginning at 11 days, by caudal expansion along entire dorsal proctodeal wall. Sequence of appearance of gland-associated connective tissue fibers was: 9.5 days, reticular fibers already present; 11 days, collagen fibers; 11.5 days elastic fibers. Serially reconstructed models of an individual glandular unit at hatching enabled classification of the unit as a simple branched alveolar gland.


Multinucleate ameloblasts in the rat incisor. Cytological examination of the rat incisor enamel organ with the light and electron microscope revealed a small number of ameloblasts which contained two and sometimes three or more nuclei per cell. A multinucleate ameloblast usually contained two vertically apposed nuclei situated near the base of the cell. A narrow cytoplasmic band was interposed between adjacent nuclear envelopes. The apical nucleus was often the more elongated of the two nuclei and it fitted a convexity or a concavity within the more basally positioned nucleus. In serial sections examined with the electron microscope no connections were observed between the nuclei. In animals injected with 3H-thymidine instances of multinucleate ameloblasts were found within the advancing front of labeling where only one of the nuclei contained label. Finally, quantitative analysis by nuclear counting established that multinucleate ameloblasts were 60 times more frequent within the maturation zone as in the secretory zone of amelogenesis. As well, the numbers of multinucleate ameloblasts increased progressively in the course of the maturation stage. It was concluded that multinucleate ameloblasts increase with cell age and likely arise by the process of cell fusion.


The free autografting of entire limb muscles in the cat: morphology. Normal or pre-denervated extensor digitorum longus (EDL) muscles were sucessfully grafted in place of the contralateral EDL muscles in cats. Histological preparations of 57 grafts were examined at intervals from 4 to 170 days after transplantation. The morphological sequence of events in a cat muscle graft is similar to that in the rat except that the time course of regeneration is considerably slower. Surviving original muscle fibers form a thin rim at the periphery of the graft. Beneath this rim, the original muscle fibers undergo fragmentation, starting near the periphery and progressing toward the center. Regenerating muscle fibers take the place of the degenerated muscle fibers. In pre-denervated grafts, the last of the original muscle fibers in the center of the graft have broken down by 41 days whereas in normal muscle grafts the original muscle fibers in the central region persist until 50 days. The main difference between grafts of normal and pre-denervated muscles is the rate of breakdown of the original muscle fibers. Long term grafts of both groups are morphologically very similar.


Putative steroidogenic cells associated with the ductuli efferentes of the ground squirel (Citellus lateralis). During a study on the fine structure of different regions of the reproductive tract of the ground squirrel, Citellus lateralis, cells possessing cytological features associated with steroid production were observed among the ductuli efferentes. Comparison of the morphology of these cells with that of Leydig and adrenocortical cells, demonstrated that they resembled Leydig cells in many anatomical details. Further evidence for the similarity of the cells associated with the ductuli efferentes to Leydig cells emerged during sexual regression, when both types of cells underwent the same regressive changes in organization and morphology. This suggests that the cells present among the ductuli efferentes are active in the synthesis of androgenic hormones, and possibly play a role in the endocrine control of reproduction in this species of ground squirrel.


Morphology and histochemistry of the mandibular gland of the Australian brush-tail possum Trichosurus vulpecula (Marsupialia). A histological, ultrastructural and histochemical study of the mandibular gland of the Australian possum Trichosurus vulpecula revealed essentially similar features as those described earlier for the mandibular gland of the taxonomically relatively unrelated American opossum Didelphis. The secretory endpieces consist of a branched tubular part, composed of serous cells whose secretion granules contain neutral glycoproteins, and terminal acini, consisting of seromucous cells containing small amounts of sialomucins. Relatively short intercalated ducts lead to striated ducts of variable ultrastructural appearance. The striated ducts run in bundles in the center of each sublobule of the gland. The possible functional significance of the abundance and variability in ultrastructure of the striated ducts is discussed.


Trigeminal nerve endings in gingiva, junctional epithelium and periodontal ligament of rat molars as demonstrated by autoradiography. Tritiated-L-proline was injected into the right Gasserian ganglion of mature rats for incorporation into proteins being carried by rapid axonal transport to nerve endings. The distribution of the nerve endings in molar gingivae and periodontium was subsequently mapped in serial sections by autoradiography. We found that sensory nerve terminals are most prominent in two regions of the free gingiva: (1) In the junctional epithelium there is a rich innervation of the basal epithelial layer with many endings penetrating several cell layers. (2) In the crestal epithelium arborized endings are present, especially on the marginal side of the crest. In the attached gingiva a few terminals are found in the epithelium with more in the lamina propria; the latter appear to be encapsulated. The periodontal ligament is only moderately labeled with silver grains located over nerve bundles, over nerves associated with blood vessels, and over a few apparent endings in the apical region. In the cementum no labeled endings are seen. Labeling of Gasserian cell bodies primarily reveals specific intra-epithelial nerve endings in gingiva crest and junctional epithelium. The absence of major labeling of the periodontal ligament supports the view that many nerves in that region are derived from cell bodies in the mesencephalic nucleus.


Glycoprotein containing vesicles in the surface epithelial cells of the ascending colon of the rat. Recently, radioautographic studies have shown that cell coat glycoproteins are transported to the cell surface by vesicles both in the amoeba (Flickinger, '75) and in the epithelial cells of the ascending colon of the mouse (Michaels and Leblond, '76). In the current morphological and cytochemical study of the surface epithelial cells of the rat ascending colon, it is shown that filamentous material, resembling the cell coat, is contained in saccules toward the mature face of the Golgi apparatus and vesicles close to the apparatus and near the terminal web. The vesicles are limited by a unit membrane composed of asymmetric osmiophilic leaflets and similar to the plasma membrane. When stained by the periodic acid-chromic acid-silver methenamine technique, silver was precipitated on the cell components containing the filamentous material indicating the presence of glycoproteins. Narrow invaginations from the cell surface that may correspond to vesicles undergoing exocytosis were also positive for glycoproteins. The distribution of the filamentous material that was glycoprotein positive parallels the pathway followed by material that had been found to be labeled with a tritiated glycoprotein precursor (3H-fucose) in the epithelial cells of the ascending colon of the mouse. It is suggested that the system of vesicles in the rat colon cells is acting in a manner similar to the vesicles in the mouse cells to transport cell coat glycoproteins from the Golgi apparatus to the cell surface.


[Intra-hepatic post-traumatic cholestasis. Apropos of 22 cases]. The authors report 22 observations of patients showing an intra-hepatic cholestasis following a traumatism. The frequency of this complication amounted to about 1.5 p. 100. Among the mechanisms of this cholestasis some factors were kept in mind: 1. the severity of the traumatism; 2. the surgical act; 3. the use of massive transfusions, the polyvisceral complications of the traumatic shock, the infectious complications. The pathophysiology of this cholestasis seems to be in relation to an increase of the production of the conjugated bilirubin. This production is associated with a decrease of the biliary excretion depending essentially on hepatic intracellular injury, secondary to: the hemorragic shock, the anoxia, the surgical intervention, the infection. From these different factors, they draw practical conclusions as much in the diagnosis of cholestasis as in the therapeutics.


Contributions of changing rib cage--diaphragm interactions to the ventilatory depression of halothane anesthesia. The ventilatory response to CO2 was subdivided into that portion due to increasing rib cage expansion, and that due to increased diaphragmatic descent. Five children were studied, awake, and anesthetized with halothane, 0.8-0.9%. During anesthesia there was a 67+/-8% reduction (mean+/-SE) in the slope of the response of overall ventilation to an increase in CO2. This was primarily due to an 89+/-8% reduction in the recruitment of rib cage ventilation (P less than .001). There was no significant change in the slope of the diaphragmatic response (anesthetized value 19+/-21% less than control), although the response curve was shifted to the right so that a higher CO2 concentration was needed to stimulate a given level of diaphragmatic excursion. Additional measurements of the inspiratory intercostal electromyogram in three adult subjects documented a rapid, profound depression of intercostal activity with halothane anesthesia that was associated with a marked decrease in rib cage ventilation. The authors conclude that a major component of the ventilatory depression associated with halothane anesthesia results from the preferential suppression of intercostal muscle function with relative sparing of diaphragmatic activity.


[Increase of anaerobic infections. Prevalence of Bacteroides. Apropos of 17 cases in abdominal surgery]. Seventeen cases of anaerobic infections in abdominal surgery are reported. Predominance of bacteroides is evident (9/17), especially bacteroides fragilis. The clinical manifestations of bacteroides infections are severe: 7 septicemias and 2 parietal infections, being the cause of the death in four patients. Bacteroides infection develops preferently in an old patient, with severe disease, in colic surgery especially in emergency. Bacteroides are characterized by their polyresistance to antibiotics: beta-lactamins, except carbenicillin, and aminosids. Metronidazole is a powerful bactericidal agent with a very low toxicity, particularly active in the treatment of these affections, as well as clindamycin. If oral route is impossible, chloramphenicol, I.V. tetracyclin, and above all carbenicillin are able to be used with success.


Sodium nitroprusside increases Qs/Qt in dogs with regional atelectasis. This study investigated the effects of sodium nitroprusside (SNP) on arterial oxygen tension (Pao2), pulmonary shunt (Qs/Qt), and pulmonary vascular resistance (PVR) in the presence of atelectasis of one lung. Ten dogs were anesthetized, their tracheas intubated with a bronchial divider, and their lungs ventilated with IPPB with pure oxygen. Atelectasis of the left lung was produced by occluding the left side of the bronchial divider and ventilating the right lung. SNP was infused to decrease mean arterial blood pressure by 25%. Pao2 decreased from (mean value+/-1 SD) 134+/-75 to 77+/-23 torr (P less than 0.05) with SNP infusion. Qs/Qt increased from 30+/-7.0 to 39+/-6.0% (P less than 0.05), while cardiac output did not change significantly. PVR of the atelectatic lung decreased, while PVR of the ventilated lung was unchanged. The decrease in PVR in the atelectatic lung suggests that SNP decreases Pao2 and increases Qs/Qt by reversing the hypoxic pulmonary vasoconstriction. As a result, during SNP infusion, perfusion of the atelectatic lung was maintained while perfusion of the ventilated lung decreased.


The anesthesia machine and circle system are not likely to be sources of bacterial contamination. Patients who had upper respiratory tract gram-negative bacillary colonization and noncolonized patients were followed through surgical procedures to determine what bacterial organisms would be deposited in anesthesia apparatus. Anesthesia machines were cultured for bacteria in many locations before and after each surgical procedure. Six machines in routine operating room use were studied after use on six colonized patients and nine uncolonized patients. Sixteen corrugated tubes from unopened packages served as controls. The results indicated that the machines remained free of bacteria of patient origin. Levels of contamination were only slightly higher in the expiratory tubing, and the bacterial species most commonly recovered were environmental in origin. Even after periods of anesthetic administration as long as six hours in patients heavily colonized with gram-negative bacilli, contamination of the anesthesia apparatus with the colonizing organisms did not occur. Intentional contamination of a sterilized anesthesia machine with two gram-negative organisms confirmed the clinical observations. Analysis of oxygen and nitrous oxide gas sources for bacteria had negative results. Basic hygienic management of anesthesia machines will ensure safety from the standpoint of cross-infection.


Histoplasma capsulatum endocarditis: report of a case following heart surgery. Clinical, laboratory, and pathologic features of a case of Histoplasma capsulatum endocarditis in a 57-year-old white male following an open mitral commissurotomy are presented. This is the second reported case of Histoplasma endocarditis following surgery. Treatment with amphotericin B failed in these two cases, though cases of Histoplasmosis endocarditis have been successfully treated. The importance of early diagnosis and treatment is emphasized.


Intracranial hemorrhage and amphetamine usage. Review of the effects of amphetamines on the central nervous system. A 25-year-old man died after an intravenous injection of 100 mg of methedrine. Postmortem studies showed visceral congestion, lung edema, pericardial petechiae, centrolobular necrosis of the liver, and diffuse subarachnoid blood, intracranial vasculitis and cerebritis in the absence of aneurysms, arteriovenous malformations or chronic hypertension. A review of the English-language literature produced 3 other cases of fatal amphetamine-induced intracranial hemorrhage and seven nonfatal cases. Some were the result of overdose, others of hypersensitivity. Angiographic evidence suggests that such hemorrhages result from the development of fibrinoid necrosis and the formation of microaneurysms in the small intracerebral vessels.


Osteomyelitis following translumbar aortography. Osteomyelitis of the lumbar spine occurred in a patient following translumbar aortography. Treatment included surgical drainage and systemic antibiotic therapy. Fever and progresive neurological dysfunction were relieved. There is controversy about the safety and efficacy of translumbar versus percutaneous transfemoral aortography. The translumbar route, is not the primary approach, is a reasonable alternative; bleeding complications are infrequent and infection is rare.


Effect of alcohol on the atrial fibrillation threshold in dogs. The atrial fibrillation threshold was measured in 10 anesthetized dogs by delivering a series of impulses directly to the right atrium after infusion of 4.5 ml of 5% glucose per kilogram of body weight, and after 1.5 ml of absolute alcohol per kilogram in 3 ml/kg of 5% glucose. There were no changes in the atrial fibrillation threshold after glucose. The mean AFT before alcohol was 6.8 volts. Immediately after alcohol infusion, the arterial blood alcohol concentration (BAC) was 300.7 mg/100 ml, and the AFT increased to 9.75 volts (P less than 0.01); 20 minutes later the BAC was 181.2 mg/100 and the AFT 8.5 (P less than 0.02). There was no rebound decrease in AFT up to 65 minutes. The findings suggest that in anesthetized normal dogs, alcohol may have a direct mild antiarrhythmic effect on the atria. Atrial fibrillation in alcoholics may be due to alcohol indirectly through electrolyte, autonomic, or histologic changes.


Effect of oral contraceptives on resting blood flow in the leg. Resting blood flow in the leg was measured twice per week by venous occlusion plethysmography, for two or more menstrual cycles in 11 normal female volunteers, 5 of whom were taking an oral contraceptive. Both groups showed a wide range of resting flow, with lowest values doubling or occasionally nearly trebling in any one menstrual cycle. In 1 subject a repeatable cyclic variation was found. The mean resting flow of the group taking oral contraceptives was found to be lower (0.1 less than P less than 0.2) and the range of flow values over the menstrual cycle smaller, than those of the subjects not using the pill. The lower flow values found for subjects on the pill suggests a possible mechanism linking use of oral contraceptives with the occurrence of venous thrombosis. However venous distensibilities estimated from plethysmographic observations indicate that the thrombogenic effect of low flow values may be offset by decreased distensibility, and hence it may be possible to maintain normal blood velocities.


Diagnostic uses of intraatrial electrocardiography. Many tachyarrhythmias present difficult diagnostic problems. In patients with underlying cardiac disease, serious hemodynamic derangements can be the sequelae of uncontrolled or improperly treated arrhythmias. Our experience, illustrated by the case presentations, confirm that intraatrial electrocardiography is a safe and reliable technique for elaborating difficult tachyarrhythmias that are not conclusively diagnosed by noninvasive ECG techniques. Because misinterpretation of tachycardias can lead to incorrect therapeutic decisions, the minimal risk of such a procedure is far surpassed by the information obtained, which allows for correct diagnosis and aids in guiding effective therapy. Although careful, critical analysis of ECG and rhythm strips frequently allows a proper diagnosis, occasions often arise when the rhythm cannot be accurately defined. In such instances an intraatrial lead electrocardiogram can be utilized and is invariably of diagnostic aid in resolving the relationship of the P wave to the QRS complexes, which is usually the important key to a tachyarrhythmia diagnosis.


Ventricular aneurysmectomy for the treatment of intractable angina pectoris. Resection of a large postinfarctional ventricular aneurysm led to termination of intractable angina pectoris in one patient. The patient has been followed for 5 years and remains angina-free, even though aorto-coronary bypass surgery was not performed in this patient. The patient presented no evidence of congestive heart failure, arterial emboli, or cardiac arrhythmia before or after the surgery. Intractable angina alone in the absence of congestive heart failure, systemic embolism, and refractory ventricular tachyarrhythmia may constitute another indication for ventricular aneurysmectomy with or without concomitant aorto-coronary bypass surgery.


Post-traumatic middle cerebral artery occlusion: case report and review. Occlusion of extracranial carotid and vertebral arteries following closed craniocervical trauma is well known. However occlusion of intracranial arteries following closed head injuries is infrequently reported. In fact only 25 cases of post-traumatic middle cerebral artery occlusion have been adequately documented. This entity bears re-emphasis not only because of its rarity but also because of its clinical similarity to other intracranial mass lesions.


Polymorphic variation in the amount of sialic acid attached to bovine transferrin. In this paper family studies are presented which support the hypothesis of polymorphism in the process controlling sialic acid binding to bovine transferrin which modifies its phenotype as seen in starch gel electrophoresis. It has been shown that this polymorphism is controlled by locus Tfs with two alleles Tfs A and Tfs a. Tfs a/a animals have the abnormal phenotype with the two faster bands of the four bands of a normal transferrin allele being virtually absent. Tfs A/a and Tfs A/A are phenotypically normal. Limited evidence is presented which suggests that the Tf and Tfs loci are not linked.


Ox erythrocyte agglutinability. 4. The effect of neuraminidase treatment on the agglutinability of cells and ghosts. 1. The inherited differential agglutinability of cattle erythrocytes is shown to be similarly expressed on ghosts and intact cells. 2. Removal of virtually all sialic acid by prolonged neuraminidase treatment does not alter the agglutinability status of ghosts prepared from either high or low agglutinable cells. Hence the differing sialic acid content of the two cell types is not responsible for the differential agglutinability. 3. The significance of these findings with respect to other well defined agglutination systems and current theories of membrane structure is discussed.


Gene frequencies of blood groups in Dutch swine breeds. Gene frequencies of blood groups at 6 loci were estimated within two Dutch breeds of swine, Dutch Landrace and Dutch Large White. At all loci there were significant differences between breeds. The relationship of the two breeds with, respectively, the Germany Landrace breed and the German Large White breed could be confirmed by the gene frequencies.


The distribution of the hedgehog (Erinaceus europaeus L.) in Finland in 1975. The distribution of the hedgehog (Erinaceus europaeus L.) in Finland was surveyed in the light of an inquiry. The range presented is based on more than one thousand answers to a questionnaire. The extension further northward of this species during the past ten years was confirmed. The distributional areas of the hedgehog in Finland in 1952, 1965 and 1975 are presented in a cartogram. In southern Finland the number of the hedgehog has clearly decreased during the past ten years (1965-1975). Some possible reasons for the decline are discussed.


Atopy and IgE in a pediatric allergy practice. In children under six years of age referred to a pediatric allergy practice the usefulness of serum IgE assay was evaluated in relation to age, symptoms, nasal eosinophilia, skin tests and family history. In more than 60% of the children the initial symptom, usually rhinorrhea, had occurred before one year of age. In infancy the diagnosis was more difficult, gastrointestinal complaints were more frequent and nasal eosinophilia less frequent than in the older children. Many infants had positive skin tests to foods and to environmental allergens. There was a significant correlation between elevated serum IgE level and age, nasaeosinophilia, the number of positive skin tests and the probability of immunotherapy being prescribed. Although no clear diagnostic level is seen, an IgE level above 100 micron/ml at any age and an IgE level above 20 micron/ml in infants strongly suggest the possibility of atopic disease. However, a low IgE level does not exclude atopic disease.


A new approach to the treatment of allergic nasopharyngitis. Orally inhaled and nasally exhaled beclomethasone diproprionate (b.d.) under increased nasopharyngeal pressure was found beneficial in ameliorating symptoms of allergic nasopharyngitis. The most spectacular help was obtained by patients suffering from sinus headache. This treatment also was found to avert the flaring up of rhinitis, an occasional "unmasking" effect of orally inhaled b.d.


Clinical evaluation of fenoterol aerosol in asthma. Fenoterol and isoproterenol metered-dose inhalers were compared in 30 asthmatic patients by a double-blind, parallel-group study. FEV1 and FEF 25-75% values recorded after single doses on days 1, 45 and 90 of a three-month continuous treatment period showed that mean increases over baseline were significantly greater and lasted longer with fenoterol.


Contact dermatitis caused by copper sulfate used as coloring material in commercial alcohol. Copper sulfate added to commercial alcohol as a coloring agent caused contact dermatitis of the hands in 10 furniture polishers. Patch tests with 5% aqueous solution of copper sulfate were positive in all these patients but negative in 15 normal controls.


The human dander atopy. I. The prototype of auto-atopy. Human dander is shown to be a true allergen giving skin reactions most frequently in atopic patients. The clinical importance of human dander is discussed and data of a group of patients atopic only to human dander are given. It seems probable that human dander is an auto allergen and that there are many more auto allergens to which the atopic organism produces IgE-type antibodies.


[Centrifugal analysis. History, general principles]. Three ideas were at the origin of the concept of rapid centrifugal analysis: automation, miniaturisation, suppleness. They led to the drawing up of a manuel for the development of a prototype including: simultaneity, miniaturisation, true time and reduction of data. The rapid centrifugal analyser may be described as a system of analysis based on the use of centrifugal force to add simultaneously in a discret way an aliquot of reagent to various aliquots of specimens and to displace the reactional mixtures in hollows equally distributed on the outer border of a rotor. The signals are detected optically. After showing the various forms of use of the rotors, the function of the module of analysis is described. The taking and treatment of data by the computer are described with special reference to their aspects in real time. Finally, a few applications are described.


[Coordinate evaluation of three types of centrifugal analysers]. A coordinated evaluation effected under the control of French Society of Clinical Biochemistry has been with three centrifugal analysers. This evaluation involved two protocol patterns: --A type protocol: realized under ideal conditions. --B type protocol: realized under usual conditions. This study involved: --Evaluations of accuracy, reliability and thermostatisation, according to A type protocol. --Evaluation of contamination within the same transfer disc (Both A and B type). --Comparative survey of reliability performed every day, with the same transfer disc, through two months (B type). --Reliability analysis, through two years; the interest of this test in the control of the centrifugal systemes underlined (B type). --Comparative economical evaluation of the three centrifugal analysers, within two typical conditions.


[Practicality of centrifugal analysis].

[Practicality of centrifugal analysis]. The practicability of a method or of an apparatus is one of the "figures of merit" which are used by the clinical chemist to choose a method or an apparatus. Joined to the reliability and the efficiency, it has to be evaluated by different tests. Unfortunately, few reflections concern the definition of this criterion, which often is little discussed in the other divisions of the pure and applied chemistry. The clinical chemist is well suited to study and evaluate the practicability. The present paper attempts to define this criterion and to set the discussion of this question.


[Determination of lactate with centrifugal analyser (Gemsaec) by lactate dehydrogenase in the presence of alanine aminotransferase]. An automated method for lactat determination on centrifugal analyser is described. The measurements have been done by end-point method during 300 seconds. A reagent blank is introduced in each run and its absorbance is deduced from those of the tests. The suitability of the method is assessed, particularly the sensitivity (detection limit) and the accuracy by checking the recovery. The results obtained by the automated and the manual method are well correlated.


[Determination of plasma creatinine with centrifugal analyser]. An automated kinetic method to determine creatinine in plasma with Jaffé reaction (alkaline picrate reagent) using a Gemsaec analyser is studied in order to argue the precision and the accuracy. The analysis of the reaction rate of a primar standard solution and of different plasmas suggests that a rapid measure is requisite in order to avoid interferences from chromogens contained in plasma which develop a same but often slower and durabler coloration at the used wavelength. The method is compared to the manual procedure using adsorption on Lloyd's reagent.


[Automatic dosage of total urinary proteins with centrifugal analyser]. Automatic assay of urinary total proteins on a centrifugal analyser. The assay of urinary proteins is achieved opacimetrically after precipitation by trichloracetic acid. The addition of tensio-active agents lates the initiation of precipitation, helps the formation of a microprecipitate thus hold in suspension. The technique is linear from 0 to 2,5 g/l and for every albumin/globulins ratio between pure albumin and pure globulin.


[Practical experiment with a Gemsaec analyser for three and half years in a routine laboratory]. The Eni-Gemsaec Fast Analyser has proved to be most efficient for the performing of the daily routine: batch testing, profile testing and stat. testing. The system offers the greatest degree of versatility and flexibility, being thus the ideal tool for research. Methods for the determinations of urea, calcium and inorganic phosphate are presented. For the volume setting two Hamilton digital diluters, remotely controlled, have been adapted to the rotoloader.


Progress and future of centrifugal analysers. Applications of centrifugal analysers to the field of clinical chemistry have been reviewed. Specific areas covered include recent developments in clinical enzymology with emphasis on aspartate aminotransferase and alkaline phosphatase. Also included are newer methods for uric acid, bilirubins and applications of enzyme linked immunoassays and immunochemical nephelometric techniques. Studies are described of the optimization of the BCG dye-binding procedure for serum albumin using an early absorbance reading.


Smoking, socioeconomic status, and chronic respiratory disease. Prevalence rates of chronic bronchitis and asthma and mean levels of ventilatory lung function were related to age, smoking habits, occupation, education, and income in 4,699 men and women living in Tecumseh, Michigan. The prevalence of chronic bronchitis was higher and mean levels of 1-sec forced expiratory volume were lower in cigarette smokers than in other men and women, and heavy smokers were affected more than light smokers. The prevalence of chronic bronchitis was higher and mean 1-sec forced expiratory volume was lower in blue collar workers than in white collar workers. Men and women with some college education had higher mean values for 1-sec forced expiratory volume than did those with less formal education, and the prevalence of chronic bronchitis was least among men with most education. Mean levels of 1-sec forced expiratory volume were slightly lower in those with the smallest incomes. There were no significant associations between the prevalence of asthma and smoking habits, occupation, education, or income. Most of the differences in the prevalence of chronic bronchitis and mean 1-sec forced expiratory volume in men and women of different occupational, educational, or income classes were due to differences in smoking habits. In comparison with smoking, poor occupational, educational, or economic circumstances had only a weak deleterious effect.


Neonatal lung defense mechanisms: a study of the alveolar macrophage system in neonatal rabbits. Abnormal function of the alveolar macrophage system may explain the enhanced susceptibility to pulmonary infection in human neonates. This hypothesis was investigated by infecting 1- to 14-day-old rabbits with aerosols of Staphylococcus aureus and then measuring in situ rates of bacterial ingestion, inactivation, and destruction in the lapine lung. The inhaled staphylococci were killed within the lungs of 1-day-old rabbits at a significantly slower rate than that for 7- and 14-day-old rabbits (P less than 0.05). Much of this decrease was due to diminished rates of bacterial ingestion by alveolar macrophages of younger animals. Staphylococci were also killed and destroyed less rapidly within these macrophages, but these differences could not be tested for significance.


Relationship between mouth occlusion pressure and electrical activity of the diaphragm: effects of flow-resistive loading. We determined the relationship between mouth occlusion pressure and diaphragmatic electromyography during CO2 rebreathing with and without inspiratory flow resistance. Diaphragmatic electromyography was measured as a moving time average; occlusion pressures were measured 150 msec after onset of an inspiratory effort against a closed airway (P.15). P.15 versus diaphragmatic electromyographic plots during CO2 rebreathing with and without inspiratory flow resistance were linear. In 3 subjects the slope of P.15 versus diaphragmatic electromyography was unchanged with inspiratory flow resistance whereas in 3 others the slope increased, indicating greater inspiratory force for a given degree of diaphragmatic activity. We concluded that under unloaded conditions P.15 is a reliable index of respiratory neural output but may no longer reflect only inspiratory motoneuron drive during mechanical loading.


The induction of pulmonary emphysema with human leukocyte elastase. Purified human leukocyte elastase was injected into the tracheas of 46 hamsters. Thirteen animals died spontaneously within 1 week, with extensive lung hemorrhage. The elastin content of the lungs was only slightly less than control values 3 hours after injection. At 2 months, the lungs of the remaining animals showed mild, patchy emphysema and morphometric changes consistent with emphysema. These results contrasted with the effects of a similar elastolytic dose of pancreatic elastase administered to 26 other hamsters in that only one animal died spontaneously, the lung elastin content 3 hours after injection was substantially decreased, and severe emphysema was present 2 months later. Leukocyte elastase appears to be capable of causing emphysema; but unlike pancreatic elastase, leukocyte elastase produces emphysema that is mild, even at a dose sufficient to produce intense lung hemorrhage and a high mortality.


Pulmonary phycomycetoma in a patient with diabetes mellitus. Phycomycetes are ubiquitous saprophytic fungi sharing with other fungi a propensity for invasion and disease production in immunologically compromised hosts. Diabetes mellitus, in particular diabetic ketoacidosis, is a common clinical setting for phycomycosis. A pulmonary phycomycetoma was diagnosed in a diabetic patient from material obtained by bronchial brushing was treated successfully with a combination of surgery and amphotericin B.


Nodular pulmonary infiltrates and septic arthritis associated with Yersinia enterocolitica bacteremia. A 58-year-old black man presented with left wrist pain, septicemia, and a chest roentgenographic pattern compatible with septic embolization. Yersinia enterocolitica was grown from joint fluid, blood, and sputum. This unusual constellation of clinical manifestations due to an organism rarely reported as the cause of human disease warrants reporting the case.


The oxygen consumption of rabbit lung slices after pneumothorax. We produced a pneumothorax on the left side in rabbits and measured the oxygen consumption of lung slices from previously collapsed left and non-collapsed right lung immediately after in vitro re-expansion. After re-expansion, the oxygen consumptions of the previously collapsed and non-collapsed lung were almost identical, 162 +/- 6.7 and 168.6 +/- 9.6 microliter of oxygen consumed per hour per mg of deoxyribonucleic acid (mean +/- SE), respectively. We concluded that 3 days of collapse does not impair the oxidative metabolism of re-expanded lung.


Contamination of a fiberoptic bronchoscope with Proteus species. We have traced an episode of contamination of a fiberoptic bronchoscope with a Proteus species to an index patient. Bacterial cultures obtained by aspiration through the fiberoptic bronchoscope from 11 of 12 subsequent bronchoscopies in 8 additional patients grew a Proteus species with sensitivities similar to those of the initial isolate. Culture of the fiberoptic bronchoscopic specimen yielded an identical organism. There were no definitive ill effects in the patients. These findings necessitated a change in our fiberoptic bronchoscope disinfection protocol as well as development of culture surveillance mechanism to detect breaks in the cleaning procedure. The importance of this and avoiding potential outbreaks of fiberoptic bronchoscope-related infeciton is emphasized.


Lung elasticity in juvenile-onset diabetes mellitus. Detailed pulmonary function analysis was performed in 20 patients with juvenile-onset diabetes mellitus and in 20 age- and sex-matched control subjects. No significant differences were found in comparisons of all lung function data obtained from these two groups. Even the parameters of lung recoil, which recently have been reported to be decreased in juvenile-onset diabetes, were within the normal range. These data indicate normal pulmonary function in patients with juvenile-onset diabetes mellitus, a finding that is in accordance with clinical experience.


Ventilatory responses to threshold loaded respiration in man. In postoperative patients one frequently observes respiratory difficulty in excess of what is indicated by physical alterations in respiratory mechanics. This would suggest that some patients lack normal compensatory mechanisms which respond to mechanical changes in the lung. It is entirely possible that inadequacy of compensatory mechanisms is present before surgery and predisposes patients to respiratory distress. In the clinical environment elaborate testing is precluded by the physical status of the patients. Thus, a noninvasive procedure has been designed to apply stress to the respiratory system in order to study the effect of stress at increasing levels of CO2. In this test a subject's respiration is measured as he rebreathes a mixture of 7% CO2 and 93% O2 from a closed system. On successive trials, fixed pressure inspiratory threshold loads are applied in sequence. With this type of load the increased work required to inspire a given volume depends only on the increased inspiratory pressure. In most normal subjects CO2 response was incrementally depressed when threshold loads were introduced. Patients with brain stem lesions showed a greater depression at higher loads. This may indicate a reduced ability to tolerate increased loads to breathing.


Popliteal aneurysms.

Popliteal aneurysms. A review of 64 popliteal aneurysms in 43 patients treated over a 14-year period revealed that thrombotic occlusion with ischemia and threatened limb loss was the most frequent complication (68%). Ten major amputations (23%) were necessary, four of which were the primary operations soon after admission. No limb loss occurred after operation in 11 patients with asymptomatic aneurysms. Direct revascularization was successful in 29 limbs (83%). Popliteal aneurysms should be resected, preferably in the asymptomatic stage, unless medical contraindications exist. Once thrombosis occurs, limb loss becomes a threatening likelihood.


Colon and rectal carcinoma: clinical experience. A 10 year clinical review of 220 patients treated for colorectal carcinoma is reported. Weight loss, abdominal pain and rectal bleeding were the leading signs and symptoms, occurring in 48.6%, 45.5%, and 42.7%, respectively. Patients treated in this series had more advanced disease, with a resectability for cure of only 37.7%. However, the overall five-year survival of 29.3% compared favorably with several other institutional reports. Earlier diagnosis and prompt treatment remain the major factors influencing ultimate survival.


Supramalleolar fracture of the ankle (Malgaigne's fracture). A retrospective study of 26 cases of supramalleolar fracture is presented. Types II and III were most common. All but the one had accompanying fibular fracture. The incidence of open fracture was 41.7% (10/24). The most common mechanism of injury was a high energy impacting force in the direction of axial compression. The supramalleolar fracture was subgrouped into four types. Twenty patients were treated by closed reduction and cast immobilization for an average of five months, six by open reduction and internal fixation, and two by skeletal traction in the early course of treatment. Of the 21 patients who were followed for an average of 33 months, only seven were found to have satisfactory results and were free from complications. Fourteen patients were found to have complications.


Spigelian hernia.

Spigelian hernia. Six cases of spigelian hernia are reported, including three unusual ones: (1) the presence of an acutely inflamed appendix in the hernial sac; (2) a patient with multiple associated hernias; and (3) a woman with a strangulated spigelian hernia occurring with endometrial carcinoma. The anatomy, etiology, clinical features and management of these hernias are discussed.


Early repair of diaphragmatic hernia to correct associated anomalies. The case of a seven-month-old infant is reported who had an eventration of the left hemidiaphragm associated with two bronchopulmonary foregut anomalies, duplication of the esophagus, and intralobar sequestration of the left upper lobe. The literature indicates that eventration of the diaphragm is associated with pulmonary sequestration in up to 50% of patients. Since the eventration itself obscures roentgenographic evidence of other foregut anomalies, the concomitant diagnosis and treatment of possible foregut anomalies is another justification for surgical repair of eventration of the diaphragm.